Genital warts: comparing clinical findings to dermatoscopic
               aspects, in vivo reflectance confocal features and histopathologic exam

Genital warts can be diagnosed through physical examination and confirmed by histopathology. Noninvasive methods are useful for ruling out other diagnoses with no harm to the patient. In this study the clinical findings were compared to dermoscopy, reflectance confocal microscopy (RCM), and to histopathology findings, in order to determine possible patterns that can aid diagnosis of the lesion. It was possible to identify structural changes on reflectance confocal microscopy that are already known by dermoscopy, in addition to cellular changes previously seen only by histopathological examination. This study shows the use of reflectance confocal microscopy in cases of genital warts, providing important information that can be used in further studies.

Condylomata acuminata; Dermoscopy; Microscopy, confocal

Authorship

John Verrinder Veasey MAILING ADDRESS: John Verrinder Veasey, Clínica de Dermatologia da Santa Casa de São Paulo, Rua Dr Cesário Mota Jr, 112, Edifício Conde de Lara, 5º andar - Santa Cecília, 01221-020 - São Paulo-SP, Brazil. E-mail: johnnyveasey@hotmail.com

MD; Dermatology Division, Department of Medicine, Santa Casa Medical School, São Paulo (SP), Brazil.Santa Casa Medical SchoolBrazilSão Paulo, SP, BrazilMD; Dermatology Division, Department of Medicine, Santa Casa Medical School, São Paulo (SP), Brazil.

Valéria Maria de Souza Framil

PhD; Dermatology Division, Department of Medicine, Santa Casa Medical School, São Paulo (SP), Brazil.Santa Casa Medical SchoolBrazilSão Paulo, SP, Brazil PhD; Dermatology Division, Department of Medicine, Santa Casa Medical School, São Paulo (SP), Brazil.

Sidney Roberto Nadal

PhD; Coloproctology Division, Department of Surgery, Santa Casa Medical School, São Paulo (SP), Brazil.Santa Casa Medical SchoolBrazilSão Paulo, SP, Brazil PhD; Coloproctology Division, Department of Surgery, Santa Casa Medical School, São Paulo (SP), Brazil.

Alessandra Cristine Marta

MD; Department of Medicine, Dermatology Division, Department of Medicine, Santa Casa Medical School, São Paulo (SP), Brazil.Santa Casa Medical SchoolBrazilSão Paulo, SP, Brazil MD; Department of Medicine, Dermatology Division, Department of Medicine, Santa Casa Medical School, São Paulo (SP), Brazil.

Rute Facchini Lellis

MD; Department of Pathology, Santa Casa Medical School, São Paulo (SP), Brazil.Santa Casa Medical SchoolBrazilSão Paulo, SP, BrazilMD; Department of Pathology, Santa Casa Medical School, São Paulo (SP), Brazil.

MAILING ADDRESS: John Verrinder Veasey, Clínica de Dermatologia da Santa Casa de São Paulo, Rua Dr Cesário Mota Jr, 112, Edifício Conde de Lara, 5º andar - Santa Cecília, 01221-020 - São Paulo-SP, Brazil. E-mail: johnnyveasey@hotmail.com

Conflict of interest: None

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (6)

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FIGURE 1
Clinical presentation of genital warts from Patient 1 (A) and 2 (B)

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FIGURE 2
Dermoscopy of Patient 1 (A) showing fingerlike pattern and Patient 2 (C) with knoblike pattern. On images B and D it is possible to see glomerular vessels (arrowed)

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FIGURE 3
Papillomatosis of Patient 1 (A) in a 5 x 5 mm view and of Patient 2 (B) in close-up, 1.5 x 1.5 mm, showing the honeycomb pattern of the spinous layer (circled)

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FIGURE 4
Comparing confocal microscopy findings with dermoscopy image. Confocal microscopy view of Patient 1 in a 1 x 1 mm area (A) and of Patient B in a 1 x 1.5 mm area (B). (C) is a dermoscopy picture. Arrows point to the vessels seen on confocal microscopy and on dermoscopy. The papillomatosis are seen on both exams, with a closer and better defined image on RCM

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FIGURE 5
Comparing confocal microscopy findings with the histopathologic image. (A) is a 1 x 1 mm view with vessels pointed out by the arrows. The same vessels are pointed on histologic image C. (B) is a 0.5 x 0.5 view showing the architectural disruption of the spinous layer without the usual honeycomb pattern. The disruption is seen on histologic image C as koilocytosis (yellow circles). On A it is also possible to see areas of the spinous layer with a honeycomb pattern (white circle)

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FIGURE 6
Images of Patient 1: confocal microscopy 0.5 x 0.5 mm at spinous layer (A), histological ex am with immunohistochemical reactions: CD1a (B) and melan-A (C). Images of Patient 2: confocal microscopy 0.5 x 0.5 mm at spinous layer (D), histological exam with immunohistochemical reactions: CD1a (E) and melan-A (F). In both cases the white dendritic cells on RCM (A and D) were evident, and proved to be Langerhans cells with CD1a throughout the epidermis (B and E); melanocytes with melan-A were only present on the basal layer (C and F)

FIGURE 1 Clinical presentation of genital warts from Patient 1 (A) and 2 (B)

FIGURE 2 Dermoscopy of Patient 1 (A) showing fingerlike pattern and Patient 2 (C) with knoblike pattern. On images B and D it is possible to see glomerular vessels (arrowed)

FIGURE 3 Papillomatosis of Patient 1 (A) in a 5 x 5 mm view and of Patient 2 (B) in close-up, 1.5 x 1.5 mm, showing the honeycomb pattern of the spinous layer (circled)

FIGURE 4 Comparing confocal microscopy findings with dermoscopy image. Confocal microscopy view of Patient 1 in a 1 x 1 mm area (A) and of Patient B in a 1 x 1.5 mm area (B). (C) is a dermoscopy picture. Arrows point to the vessels seen on confocal microscopy and on dermoscopy. The papillomatosis are seen on both exams, with a closer and better defined image on RCM

FIGURE 5 Comparing confocal microscopy findings with the histopathologic image. (A) is a 1 x 1 mm view with vessels pointed out by the arrows. The same vessels are pointed on histologic image C. (B) is a 0.5 x 0.5 view showing the architectural disruption of the spinous layer without the usual honeycomb pattern. The disruption is seen on histologic image C as koilocytosis (yellow circles). On A it is also possible to see areas of the spinous layer with a honeycomb pattern (white circle)

FIGURE 6 Images of Patient 1: confocal microscopy 0.5 x 0.5 mm at spinous layer (A), histological ex am with immunohistochemical reactions: CD1a (B) and melan-A (C). Images of Patient 2: confocal microscopy 0.5 x 0.5 mm at spinous layer (D), histological exam with immunohistochemical reactions: CD1a (E) and melan-A (F). In both cases the white dendritic cells on RCM (A and D) were evident, and proved to be Langerhans cells with CD1a throughout the epidermis (B and E); melanocytes with melan-A were only present on the basal layer (C and F)

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