[Question #7870] HPV vs Skin tag question for Dr. Hunter Handsfield
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51 months ago
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I've found myself in an uncertain quagmire:
I found a single, small, pebble-like, skin-colored yellow-ish bump about 1/3rd of an inch away from my penis on my groin under my pubic hair and assumed it was a hair follicle issue. After 3 weeks and no progress I decided to get it looked at by a nurse, who told me it as a wart and had it treated with cryotherapy. It turned black but did not blister or fall off.
A week later I went to see a dermatologist who told me it could be a wart but it was very likely to be a skin tag or something else. He offered to remove it entirely by shaving it off and said that if I didn't see any bumps return, it wasn't a wart, but if I did see it come back, then it could be considered a wart. I asked about the possibility of having it biopsied to which he said the previous cryotherapy could easily confound the results but it was worth a try.
The dermatologist told me the results from the pathologist came back "suggests hpv", and that this was not a confirmation, especially given that the lesion had been frozen a week previously. He said it was definitely more likely to be a wart in this case, but if I don't see any more appear, it's still "probably" not hpv, but overall he felt it was all up to probabilities.
This leaves me a bit befuddled with the following questions:
1. How reliable is a biopsy of a lesion that has been frozen for a week?
2. Is my dermatologist correct in his assessment that given the appearance and location of the bump, if I don't see any lesions come back, that this isn't HPV?
Thank you for your time!
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Edward W. Hook M.D.
51 months ago
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Welcome to our forum and thanks for your question. I’ll be glad to comment however even as I begin, I must warn you that having had this lesion treated makes it difficult to provide a precise answer, even with a biopsy. The area in your groin where the lesion is described is an unusual place for warts. The vast majority of warts in men tend to occur directly on the penis or occasionally on the scrotum. The color of the lesion you describe-yellowish- is also somewhat unusual for a typical wart. Finally, like the majority of therapies for HPV, cryo-therapy with liquid nitrogen is essentially a destructive process in which tissue is frozen, allowed to thaw and then frozen again. This process destroys the tissue and cells of the lesion, allowing normal cells to regrow. Unfortunately, the same destructive process makes interpretation of a biopsy challenging at best. Thus, in answer to your questions:
1. The dermatologist is correct in the course of action that he/she suggests is the correct way forward. Following the destructive effects of cryotherapy it interpretation of biopsies is very difficult. Should the lesion regrow it can be re-biopsied for a definitive answer as well as retreated. As I have already mentioned many of the characteristics of this lesion are unusual for HPV.
2. Yes
I hope this information is helpful. Please note that the vast majority of genital lesions are not HPV. Unfortunately all to many clinicians with less experience assume that all genital lesions are HPV and treat them without being sure of what they are. This leaves patients such as you in a quandary.. Should the lesion recur (this could take several months, if it has not recurred in six months it is unlikely to do), I would encourage you to return to the same dermatologist and saw you originally and not to avail treatment until any questions you might have have been satisfied. EWH
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50 months ago
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First and foremost thank you so much for your reply and the work you do on this site.
An update:
My derm spoke with the pathologist, who felt as if the biopsy results were too uncertain and recommended an"HPV type test." I'm not sure which one they ordered. My derm mentioned antibodies but I'm aware some tests use DNA and antibodies and probably other methods I'm unaware of.
I followed up with my derm who said that there was enough viable tissue in the sample and that the cryosurgery in the case of this test didn't matter.
I did, however read a post here that mentioned the lack of reliability of hpv tests even if fa approved (in that case for an oral hpv test). I also read elsewhere that hpv DNA tests have very low false negatives but sometimes false positives, so I'm a little confused how solid my results will be when they come back. What is your take on this?
I am also wondering what your opinion is on having an HPV test run on on a cryo'd lesion that still has some intact tissue in it?
Will I get a reliable result from this test in spite of the microscopic biopsy test being less reliable in this case?
I understand hpv overall isn't a huge deal, and I trust my derm and the pathologist's opinion, but the uncertainty of this situation and the conflicting things I've read online have me a little distraught.
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Edward W. Hook M.D.
50 months ago
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Thanks for the update. It was interesting to hear of the discussion between your dermatologist and the pathologist. I am not a pathologist but from the sounds of things the pathologist seems to feel that while the prior cryo-therapy may have distorted the biopsy in terms of his/her ability to examine it microscopically, he/she seems to feel that there could be sufficient DNA for testing. The topic of using post-therapy specimens for DNA testing is certainly not my area of expertise but it sounds reasonable.
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I suspect that the discussion of DNA/antibodies relates to methods for trying to detect HPV DNA in the biopsy specimen. Sometimes these tests do use antibodies as well as DNA reagents.
Regarding the reliability of DNA detection tests, if the test is positive it is most likely an accurate reflection of the presence of HPV DNA. On the other hand, the possibility of false negative tests is difficult to determine, particularly in your situation in which the tissue being studied may have been damaged by your earlier therapy.
Finally, I want to comment once again on your statement regarding the fact that you have been looking to clarify things on the Internet. Please don’t! Certainly there is useful information on the Internet but, as you point out, there is also a spectrum of conflicting and all too often, misleading statements. The information found on the Internet is not edited and contains statements which are often Out of date, taken out of context, or are just plain incorrect. My strong advice is for you to rely on your dermatologist for reliable information. It sounds as though the information you have received thus far is on target.
I hope this perspective is helpful. EWH
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50 months ago
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Thank you. Understood.
I appreciate your comments, though I am disheartened by the possibility of a false negative. I was under the impression that false-positives were more likely than false-negatives for HPV tests like these. Is there a way I could determine the potential of this outcome? Perhaps by speaking with the pathologist directly?
For me a 1% possibility of a false-positive result would be pretty negligible, but a ~30% possibility would be pretty alarming.
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Edward W. Hook M.D.
50 months ago
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Final responses. I want again need to state that I believe you are spending entirely too much time and emotional energy on your concerns over an inconsequential possibility. Further, I would add that the likelihood of a false positive is very, very low. Your questions are best directed at your dermatologist And not to the pathologist.
As Mentioned above, this will complete this thread. Take care. Please try not to worry. EWH
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50 months ago
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Ah, apologies, I mis-wrote. I was concerned about a false-negative, not false positive. My concern is that this aspect is more ambiguous and leaves my results more uncertain. I will speak with my derm and not the pathologist per your advice.