bowenoid papulosis

[sigma1]

I was recently diagnosed with HPV after the dermatologist biopsied a very slightly raised brown spot on my scrotum.  She then had me come back in to remove 2 more brown spots that she didn't remove the 1st time, which weren't raised and looked a little different. I pointed out several smaller brown spots around the ring of foreskin (I'm circumsized) and one tiny brown dot at the tip of my penis and expressed concern that they were warts, too.  She sensed my concern and said to call them freckles for now.  I assume she's trying to calm me, and that they're probably warts, as they've popped up in the last year or two (my HPV infection is a few years old-I've been monogamous for 3 yrs).  They look just like pictures of BP I've found on the web, and I assume that's what they are (I've not seen any pics of genital warts that look like my spots).  My question is that do I need to have any extra concern (assuming it is in fact BP) in addition to the normal HPV concerns. I'm referring to penile cancer which is @ a 2% rate for BP.  Is that mainly in uncircumsized, immunosuppressed men or men that let spots spread unchecked? Basically, what are my chances of getting it if I have BP (please assume I do, just for arguments sake)?  My derm. said that my wife and I are at basically no risk for anal(we've had unprotected anal twice), oral, penis, and cervical cancer as long as she gets paps and it's ok to continue to have oral sex (she said I have NOTHING to worry about).  Would this advice change if its BP?  To me, a 2% chance is worth worrying about (or are MY actual chances much lower?).  Also, if it was BP, would the biopsy have said so (she did a DNA test and it wasn't 16 or 18, I think that's what she said).  I suppose the 1st wart could be HPV and the rest BP since they looked slightly different, but what do you think? Thanks!

[Edward W Hook, MD]

It is time for this post to end.  One of the reasons we do this is to try to help relieve anxiety.  In your situation we seem to be feeding it,  This will be your last answer; further questions wil be deleted without response. If you have further questions I would advise you to take them to a health care provider whom you trust and have an established relationship with.  As for your questions:

1.  Most likely benign and likely unrelated.
2.  No
3. The are not BP of the lip
4.  No
5.  It is not.  Do not change your normal activities.

EWH

[sigma1]

Thanks,
Out of curiosity:
1.I have a brown speck and another small brown spot on my lip, is that likely the same thing and if it is, should I be more concerned than with my groin(I haven't had them my whole life)?  
2,Are these spots contagious like a wart?
3.If they are BP, can I pass it by drinking from someone's cup?
4. If I've only had oral sex with someone, while having these spots on my penis, should I notify that person (it was a couple years ago).
5. Lastly, how easily is this spread? Can it be spread to my anus by using the towel on my groin,  then my backside (same thing for face).  Should I avoid touching my mouth/face after touching my groin, etc.

Sorry for the 20 questions, I'm just unsure about too many things.

[Edward W Hook, MD]

Straight to your questions:

1.  As folks age, we all tend to accumulate new pigmented lesions.  Once they appear they do not resolve.  As far as the BP question, now that you know you have it,periodic evaluation by your dermatologist is recommended.  Trust your dermatologist.
2.  See above.
3. Most unlikely
4.  Regualr warts are not "pre-cancerous" (did you check ou the web site I recommended?).  The HPV infections that are "precancerous" are hard, if not impossible to visualize.  Once agian. let me emphasize that only a proportion of so-called precancerous lesions actually progress and in fact, most resolve without therapy.  
5.  This is not a problem for men.  Women are monitored with Pap smears.
6.  That is my suggestion.  I cannot imagine who would.  It really makes little sense.  HPV infection is not spread by clothing.
7.  Tiny.  I cannot provide a number.  The right thing to do is to, as I've already suggested, continue your follow-up with your dermatologist.

EWH

[sigma1]

Thanks for the timely reply!  The threat of cancer is a bit scary, so I have a couple follow up questions if you don't mind.

1. The derm called them freckles, but given they appeared a couple years ago and there's about four (3 around the foreskin and 1 on the tip), isn't it very likely to be BP (basically, how common is it to get these types of "freckles" in the manner I did w/o it being anything?
2. They've been there a few years, how likely is it they'll resolve on their own?
3. Can they spread cancer w/o changing appearance on the surface? How likely is it?
4.Are they pre-cancerous in the same way a regular wart is?
5. Is it possible to have these lesions internally, where they can't be monitored?
6.I read that you suggested washing clothes separately to avoid spreading, is that necessary and what other steps are needed?
7. Finally, what are the odds (guestimate #'s if you have to) of me or my wife getting cancer from this (I assume it's easily treated, but I'd rather not stay up at night worrying)? I saw that you said circumsized men don't get cancer, is that true even in my case, and do you have any #'s you can give for piece of mind (like odds)?

Thanks very much!!

[Edward W Hook, MD]

Believe your dermatologist and feel comfortable that you are receiving good care.  Should you have BP, it is a sequelae of HPV infection and can be a precancerous lesion.  so what.  You know it, you are under the care of a dermatologist and she is willing to follow you closely and treat as is appropriate.  Your situation is much like that of a woman with an abnormal pap smear, IF YOU HAVE BP.  That is to say, you can be followed prospectively for changes, with additional biopsies as needed and receive treatment guided by those biopsies.  This is the best case scenario.   It would be far worse of you were not under the care of a competent dermatologist.

As for sex with your wife., once again, I agree with your derm.  What is done is done.  Not need to modify behaviors now, nor to point fingers.

My advice.  Calm down.  Work prospectively with your dermatologist and realize that, in the unlikely event that your lesion should progress, the dermatologist can treat it without difficulty.  Take care .  EWH