Follow-Up to "Bumps in Groin" 2/24/09

[MakaveliMOB]

Dr. Rockoff-  I really need your opinion on the following matter. I had the dermatologist look at the lesions in the groin area, and clinically he mentioned that they looked like skin tags, and because they were in the inguinal area, they were most likely skin tags. So convinced, I let him used the electro-cautery machine to burn off the lesions, but the one with the"hair" in or through it or at the side of it, I had him biopsy.

Well the results came back today, and it said that it was a Benign Keratosis, the Differential Diagnosis being a Seborrheic Keratosis or an old Verruca.

The doctor said this was preliiminary and that he should get a more detailed report soon, but that shouldnt change much, just add more detail. This is very confusing to me as I have read many studies on HPV and some indicated that Keratosis or Seborrheic Keratosis that are found in the genital region, are really Genital Warts, where the "koilocytes" are not seen by the dermatopathologist.

I have to say that this lesion was not in an area where it would have came in contact with a woman's genitals, it would be very hard to. However, a long time ago I had a lesion on my inner thigh, and it also came back as a Benign Keratosis.

I really need to understand if I have a Veneral Disease.

My Questions are as follows.

1.) Have you read similar medical studies that have concluded Keratoses in the Genital area as Genital Warts? Your thoughts?

2.) If the dermatopathologist doesnt see koilocytes, should it be assumed to be just a plain vanilla Keratosis?

3.) What is really meant by a "differential diagnosis?" I thought a biopsy is as clear as one can get.

4.) The dermatopathologist has the diffential diagnosis as an old verruca, but what is meant by verruca? A Common Wart?

5.) Have you seen common warts transferred to the inguinal or genital area, in your practice?

  dont have any lesions on my penis, pubic area, or scrotum Please advise.

[MakaveliMOB]

Are Koilocytes the only thing that distinguish a Keratosis from a Wart? Or are there other histological features?

What are some causes for a Keratosis? I always have irritation and dryness in that area, and now chaffing, could that have caused it?

My Derm said that if I really wanted to know, there is an ImmunoPhenotype test that can be performed on the lesion, but he said it can also provide false positives because HPV is on the skin even when a lesion isnt present.

I'll let you know if I end up doing that.  I just want closure to this, and I feel like the pathologist is dancing around what I'd like to know.

[Alan Rockoff, MD]

1.) Have you read similar medical studies that have concluded Keratoses in the Genital area as Genital Warts? Your thoughts?

No studies.  I agree that kerartoses in the groin can sometimes be warts, but if the pathologists couldn't find wart findings under the microscope, then there's no more that can be said except that they didn't find them and only found a keratosis.

2.) If the dermatopathologist doesnt see koilocytes, should it be assumed to be just a plain vanilla Keratosis?

Yes.

3.) What is really meant by a "differential diagnosis?" I thought a biopsy is as clear as one can get.

Wrong.  A biopsy is a test.  All tests, like all examinations, suggest a range of options.  Sometimes the range is narrow, sometimes wider.

4.) The dermatopathologist has the diffential diagnosis as an old verruca, but what is meant by verruca? A Common Wart?

An old wart.  And old wart in the groin is an old genital wart.

5.) Have you seen common warts transferred to the inguinal or genital area, in your practice?

Yes.

I understand your concern, but you want more precision than is available.  If your doctor thought they didn't look like warts and the biopsy didn't show warts, then you should presume they weren't.  In any case, all you can do even if they are warts is to remove them, and you already have.

Best.

Dr. Rockoff