Birthmark, Mole, HPV?

Dear Dr. Rockoff,
Thanks for taking the time for answering this question. Yesterday I noticed something that looked exactly like a birthmark, in both color and size, on the head of my penis. The dermatologist diagnosed it as a genital wart, and burned off the growth with a laser.

A couple things struck me that made me question his diagnosis:

1) My only sexual encounter over the past 4 months exactly one week ago. I received oral sex without a condom; I used a condom when we engaged in vaginal sex; there was no condom breakage.The birthmark-like blemish in question was on the head of my penis, and that was unmistakebly covered throughout the vaginal intercourse. It seems odd that a blemish would emerge on the head of my penis.

2) If HPV symptoms show up early, they will normally first appear after 2-3 weeks. Normal time to first symptom seems to be around 3 months. Yet my sexual ecounter happened just one week before daignosis - no later, no earlier. Is the 1 week duration for first symptom appearance consistent with other HPV cases?

3) The growth was exactly the same in color and shape as other birthmarks on my body: nearly black in color, ever so slighty raised (jsut like a birthmark), and the size of a blunt pencil point. Granted HPV strains are numerous and varied, but I searched and searched online for descriptions of similar HPV growths, and could find none that one could mistake for the growth I saw on my penis. The doctor conducted no biopsy. The assumption was that the growth was HPV, then simply straight to laser.

I am left to wonder if the doctor that removed the birthmark-like growth may have just had an itchy laser finger. What do you think about my case? Have you had patients that have birthmark-like growths spontaneously appear on their genitalia in adulthood? Do these cases normally turn out to be HPV or simply birthmarks? Are they easy to diagnose?

[Alan Rockoff, MD]

Of course, you realize that I can't tell you what this spot was because I didn't see it.  I'm not sure where you got your information about how long it takes after exposure for a wart to appear, but it's not accurate.  Warts can appear years after exposure, so your recent encounter is not very relevant.  Having said that, I would add that genital warts are not common on the penile head.  I would add that the marks you show me pictures of don't look like warts.  I can't imagine that you had a spot that dark on the head of your penis for very long without noticing it, which makes the diagnosis of mole unlikely.  In any case, even if it was a wart, it sounds as though it was taken care of, which is pretty much all you can and need to do.

I realize that I haven't given you the certainty you ask before, but that's because I can't.  You might want to ask the doctor who took care of you about the certainty of his diagnosis.

Take care.

Dr. Rockoff

[The Hamburglar]

For you reference, the blemish looked like this birthmark, but darker, a bit less than a square millimeter, and positioned on the glans (glands) near the base: http://medimages.healthopedia.com/large/birthmark-pigmented.jpg

The blemish was a single, flatish unit and  was not clustered, fleshy and unpigmented like nearly all the pictures of genital warts I've encountered while perusing the Web.

[The Hamburglar]

The marking looked very much like this "nevus" - which is a new term for me: http://www.mmh.org.tw/taitam/derma/Images/nevus.jpg