Results: verrucous keratosis

R inguinal fold, VV vs SK, DP22-1519 ... 0.2x0.2 cm skin shave biopsy, excised to a depth of 0.1 cm ... The epidemis shows acanthosis. Significant cytologic atypia is not noted. Prominent keratohylin granules and koilocyets are seen. The underlying dermis shows few nests of inflammatory cells. The lesion extends to the deep and peripheral margins of the shave biopsy.  Two additional levels were obtained and reviewed.

Diagnosis: pedunculated seborrheic keratosis no condylomatous features seen

Result: Irritated seborrheic keratosis

L upper inguinal fold ... 0.3x0.2 cm skin shave biopsy, excised to a depth fo 0.1 cm ... There is parakeratosis overlying the lesion. There is acanthosis and papilomatosis of the epidermis. The lesion is lined by basaloid cells and in the center some squamatization is noted. Significant cytologic atypia is not noted. A brisk inflammatory infiltrate is seen at the dermal epidermal junction. Mitotic figures are not prominent. The lesion is present at the peripheral shave margin. Two additional levels were obtained and reviewed.

I had another similar growth that shriveled up, turned black, and fell off on 8/29/22.  The one on 2/20/23 a PA at the County STD clinic said she thought it was a HPV wart.

I do have seborrheic keratoses on other parts of my body, but none in my groin area.

Is there any way to know if I picked up genital warts or not?

But honestly I don't see what you don't understand or why. "Is there any way to know if I picked up genital warts or not?" Yes, indeed: believe your biopsy results. Seborrheic keratosis is among the most common of all skin growths in persons your age, and your biopsies all confirmed that diagnosis. In fact, the one from 2022 includes "no condylomatous features seen". That means the pathologist specifically looked for evidence of wart/HPV and found none.

In addition, new genital warts are very rare at your age -- because most people by then have been exposed and infected to the wart-causing HPV types, and by your age are immune.

If you remain concerned, I suggest you have some further discussions with your dermatologist. Let me know if anything isn't clear.

HHH, MD

When I spoke to the dermatologist about the first growth, she said that the pathologist wasn't really clear on whether or not it was a wart and said they could do a test to see if there was HPV on the sample. I didn't know if the test was accurate or not and was reluctant to go through insurance, so we cut the other growth off instead. So in my mind, that first diagnosis isn't complete. I asked the dermatologist recently if we could still do the tests, but since so much time has passed, the pathologist said it wouldn't be accurate. The dermatologist also seemed to imply that different pathologists might have different opinions about the same sample - like one would call it a wart and another would call it something else. So now I have less confidence in the results. I thought that maybe if someone here read the descriptions themselves it would somehow be definitive. Maybe I'm asking too much.

I had another growth later in 2023, but I panicked and pulled it off. After that one, I haven't had any more of those growths, and I understand it takes about 2 years to clear HPV. Is that just coincidence?

I have had only 4 sexual partners in my life and 0 before marriage, so while I appreciate the statistics, I don't feel like they apply to me.  

My new dermatologist did say that because the other diagnoses came back as seborrheic keratoses and because I have those on other parts of my body, it makes it more likely that the first one was also a seborrheic keratosis. I just wish there was a way for things to be more definitive. Are there other tests that can be done? Can I have them send that old sample to another pathologist for a 2nd opinion?

"...while I appreciate the statistics, I don't feel like they apply to me" is wrong. Most people acquire HPV by the time they have had three lifetime sex partners.

It is true that once a tissue sample is prepared for routine microscopic analysis ("fixed" is the term used by pathologists), it often is not possible to use the tissue for other purposes, such as genetic or other testing for HPV. It has to do with the chemicals and other processing used. Still, my understanding also is that the routine microscopic analysis -- that "no condylomatous features were seen" -- is conclusive that HPV/wart was not involved.

You have genital/pubic area seborrheic keratoses, that's all. There isn't the slightest justification to be worried about whether somehow wart tissue were incorporated in the biopsy sample. And as I said above, there is near zero chance that at your age the chance you acquired a new HPV infection that could cause warts from your latest sexual adventure. Do your best to accept the reasoned science based reassurance you have had both here and from your dermatologist.

Truly, you have nothing to worry about!

That concludes this thread. I hope the discussion helps you at least start to move on with no further worries about any of this. Best wishes to you.