Followup to Biopsy vs Derm

[BiopsyBoy]

Happy Holidays, Dr Rockoff.  Thanks for answering my earlier question. I decided to do some research to try to figure out what conditions could show what my biopsy did, but have come up with just more questions and confusion.  I'm retyping my biopsy results for your convenience below, as well as the full text of the "notes" section (I paraphrased the last time.)

DIAGNOSIS: Inflamed Pigmented Squamous Acanthoma.
NO ATYPICAL CELLS OBSERVED
MICROSCOPIC DESCRIPTION: Sections demonstrate expansion of the epidermis by bland keratinocytes with associated cytoplasmic melanin pigmentation. Overlying hyperkeratosis is noted. There is perivascular lymphocytic inflammation.
Notes: No atypical cells observed. Due to anatomical site, underlying HPV effect cannot be entirely excluded. Clicial correlation advised. (Whatever THAT means!)

Just to remind you, you stated you believed the lesion (longish, with a ragged top, located in the groin/inner high) to be a skin tag, my derm insisted it was a wart (although he said it was a "common" one.)  My questions are summed up in the following points:

1.) Since there was no atypia found, and no koilocytes, papillomatosis, or parakeratosis, does that prove it's not a wart?
2.) What microscopic description must be found to diagnose a wart?
3.) None of the information on skin tags I found showed this description, although it seems a million lesions can cause the above result. Can you think of any that it might be?
4.) Can a skin tag have a jagged top (like the top was ripped off?) The other ones I have (under my arms, etc) do not show this.
5.) Do doctors put what they think the lesion is on the paperwork when they send it in for biopsy?
6.) Should some type of atypia be present for it to be a wart? If this is an old lesion would it make the microscopic wart characteristics disappear (I don't know how long the lesion was present.)
7.) Does the fact that inflamation (inflammation) was present indicate infection or can irritation cause this?

I thank you sincerely for taking the time to read this and I look forward to your reply.  My own dermatologist is very aggressive (as I stated, he swore up and down that I had molluscum which I did not.)  I really like your calm, patient approach on this forum and I have learned a lot.    Your time is very much appreciated

Thanks,
BiopsyBoy
(Trying rather succesfully to stay on the calmer side of panic.)

[Alan Rockoff, MD]

To be frank, I really don't see what there is to panic about.  Yes, doctors put down what they think on the pathology requisition form.  In my experience, pathologists don't often find the absolutely decisive changes that make a wart diagnosis certain.  Your report is not conclusive in this way.  You can read it as many times as you want, but it still won't be conclusive.  As long as the growth is gone, there isn't anything more to do anyway.  Does that mean that you may have had a wart?  Yes, it does mean that.  Should you change your life as a result?  No, you should not.

By the way, you really ought to discuss lab results with the doctor who ordered them.  If you don';t feel comfortable talking to him, then you need to find a doctor you feel comfortable talking to.

Best.

Dr. Rockoff

[BiopsyBoy]

Forgot to mention, the Derm put the wrong location on the biopsy paper work, he said it was from the perenium, when it was actually in my groin/inner thight area, if that makes any difference.

[Alan Rockoff, MD]

It doesn't.

Dr. Rockoff