Usefulness of dermoscopy in anogenital warts: A descriptive study of 30 cases

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DOI: 10.1002/jvc2.545
LETTER TO THE EDITOR
Usefulness of dermoscopy in anogenital warts:
A descriptive study of 30 cases
Dear Editor,
Dermoscopy applications are expanding beyond skin
tumours to include various other cutaneous disorders,
such as inflammatory and infectious dermatoses. Ano-
genital warts (AGW) are the most common sexually
transmitted infection.
1
Our objective is to describe the
dermoscopic characteristics of AGW.
We conducted a monocentric prospective study in the
dermatology department of Farhat Hached Hospital in
Sousse, Tunisia, from 1 January to 31 August 2023. All
clinically diagnosed cases of AGW were included. Each
patient underwent a clinical examination, a dermoscopy
and a biopsy.
Thirty patients were included in the study, with a
mean age of 34.24 years (ranging from 3 to 63 years).
The male‐to‐female ratio was 3.28:1. Among the males,
52.17% of warts were located in the penile area and
43.47% in the perianal area. For females, all warts were
located in the vulvar area. The papular warts repre-
sented 53.33% of the described lesions, condyloma
acuminata 40% and Buschke−Lowenstein tumours
were observed in two patients (6.66%). The dermo-
scopic pattern was mosaic‐like (Figure 1a). In 53.33%
of cases, corresponding clinically to the papular warts.
Afinger‐like pattern (Figure 1b) was seen in 13.33% of
cases, a cerebriform pattern in 13.33% of cases and a
knob‐like pattern (Figure 1c) in 10% of cases. In two
female patients aged 18 and 55, the dermoscopy
revealed finger‐like structures but with separated bases
and clinicopathological correlation concluded to ves-
tibular papillomatosis. In a male patient with HIV,
dermoscopy showed a cerebriform pattern (Figure 1d)
in all warts, and in one wart, it revealed a whitish
structureless area, a yellowish keratin area and poly-
morphous vessels. Malignancy was suspected, and a
biopsy guided by dermoscopy confirmed invasive well‐
differentiated squamous cell carcinoma (SCC). All
patients underwent biopsies confirming the diagnosis
excepting two female patients with vestibular papillo-
matosis. However, HPV typing was performed for only
five patients due to limited availability. It showed low‐
risk HPV 6 and 11 in three male patients and negative
fortwootherpatients.
AGW are a major risk factor for multiple malig-
nancies, including cancers of the cervix, vagina, vulva,
oropharynx, anus, penis and skin.
2
AGW are mostly
diagnosed with the naked eye, but early‐stage diag-
nosis can be challenging.
3
Three principal dermo-
scopic patterns have been described, though none is
specific. Consistent with our findings, the mosaic
pattern is the most common. It resembles common
warts, with a whitish network surrounding central
dotted or glomerular vessels.
4
This pattern is associ-
ated with papular warts and can coexist with other
patterns.
The finger‐like and knob‐like patterns are more
commonly reported with exophytic condyloma acumi-
nata. They are characterized by whitish, finger‐like or
knob‐like papillae with varying heights and fusion at
their bases. Inside the papillae, elongated and dilated
vessels are more prominent at the periphery, caused by
nitric oxide produced by HPV.
5
JEADV Clin Pract. 2025;4:293–295. wileyonlinelibrary.com/journal/jvc2
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© 2024 The Author(s). JEADV Clinical Practice published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.

The cerebriform pattern is reported in pigmented
keratotic lesions and mimics seborrhoeic keratosis.
6
The
association of two patterns, most commonly finger‐like
and knob‐like structures, has been reported.
7
Dermo-
scopy is also useful in differentiating (AGW) from ves-
tibular papillomatosis and pearly penile papules, which
show more irregular projections with tapering ends and
separated bases.
8
Other differential diagnoses include
Fordyce's spots, molluscum contagiosum, lymphangio-
mas and angiokeratomas, which are easily identifiable
with dermoscopy. The dermoscopy of invasive SCC
reveals keratin and vascular features. Keratin appears as
white‐to‐yellow structureless areas, white circles and
white clods. As seen in our patient, dermoscopy is
invaluable for detecting malignant transformation and
guiding the biopsy.
9
In conclusion, dermoscopy is crucial for AGW, aiding
both in differential diagnosis and the early detection of
SCC, particularly in immunocompromised patients.
KEYWORDS
Dermoscopy, Genital HPV, Human Papilloma Virus
AUTHOR CONTRIBUTIONS
Marouane Ben Kahla: Conceptualization; writing—
original draft. Lina Bessaad: Investigation; resources.
Nadia Ghariani Fetoui: Supervision; review and edit-
ing. Maha Lahouel: Investigation; resources. Sarra
Saad: Investigation; resources. Mohamed Ben Rjab:
Investigation; resources. Jacem Rouatbi: Investigation;
resources. Haifa Mkhinini: Investigation; resources.
Zeineb Nfikha: Investigation; resources. Dorra Chiba:
Investigation; resources. Cyrine Chelli: Investigation;
resources. Oumayma Ben Rejeb: Investigation, writing
review. Najet Ghriani: Investigation; resources. Ba-
dreddine Sriha: Investigation; resources. Nadia Ben
Lasfar: Investigation; resources. Sana Mokni: Review.
Amina Aounallah: Review. Mohamed Denguezli:
Supervision; validation; writing—review and editing.
FIGURE 1 Dermoscopic patterns of anogenital warts: (a) Mosaic pattern; red arrow: Dilated linear vessel with white halo, (b) blue
arrow: Finger‐like pattern, (c) green arrow: Knob‐like pattern and (d) cerebriform pattern in a pigmented Buschke−Löwenstein tumour.
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LETTER TO THE EDITOR

CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are
available on request from the corresponding author.
Thedataarenotpubliclyavailableduetoprivacyor
ethical restrictions.
ETHICS STATEMENT
All patients in this manuscript have given written in-
formed consent for participation in the study and the use
of their deidentified, anonymized, aggregated data and
their case details (including photographs) for publication.
Ethical Approval: not applicable.
Marouane Ben Kahla
1
Lina Bessaad
1
Nadia Ghariani Fetoui
1
Maha Lahouel
1
Sarra Saad
1
Mohamed Ben Rjab
1
Jacem Rouatbi
1
Haifa Mkhinini
1
Zeineb Nfikha
2
Dorra Chiba
2
Cyrine Chelli
3
Oumayma Ben Rejeb
3
Badreddine Sriha
2
Nadia Ben Lasfar
4
Sana Mokni
1
Amina Aounallah
1
Najet Ghriani
1
Mohamed Denguezli
1
1
Dermatology Department,
Farhat Hached Hospital, Sousse, Tunisia
2
Pathology Department,
Farhat Hached Hospital, Sousse, Tunisia
3
Gynecology Department,
Farhat Hached Hospital, Sousse, Tunisia
4
Infectiology Department,
Farhat Hached Hospital, Sousse, Tunisia
Correspondence
Marouane Ben Kahla, Dermatology Department,
Farhat Hached Hospital, Sousse 4000, Tunisia.
Email: mar1benk@hotmail.com
Funding information
None
ORCID
Marouane Ben Kahla http://orcid.org/0009-0000-
6367-7295
Nadia Ghariani Fetoui http://orcid.org/0000-0001-
8556-7919
Jacem Rouatbi http://orcid.org/0000-0003-3795-0846
Haifa Mkhinini http://orcid.org/0000-0002-3567-4238
Sana Mokni http://orcid.org/0000-0001-8640-7511
Mohamed Denguezli http://orcid.org/0000-0002-
4176-2744
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