Unmasking the Giant Condyloma: A Case Report and Literature Review of Buschke-Löwenstein Tumor

Buschke-Lowenstein tumors (BLTs) are rare, slow-growing, cauliflower-like lesions of the perineal region. Despite its benign histology, it may be a precursor of squamous cell carcinoma (SCC), as it possesses the potential for malignant transformation. Multiple sexual partners and early sexual debut are among the main risk factors. Topical therapy and minimally invasive excisional therapies may be applied in mild cases. Radiotherapy, chemotherapy, and immunotherapy have also been described, presenting limited efficacy. Surgery remains the gold-standard treatment, especially for extensive lesions, as demonstrated in our case. We report the case of a heterosexual 33-year-old male patient with extensive penoscrotal, pubic, inguinal, and perineal anodyne lesions, ongoing for 14 months. In the past two years, two different sexual partners were reported. Due to the extent of the lesions, a multidisciplinary approach was required, consisting of a urologist and a plastic surgeon. The histopathological analysis confirmed the original diagnosis of a BLT consistent with human papillomavirus effect, ruling out any possibility of malignant transformation to SCC. Skin flaps were used to reconstruct the skin defect. A complete wound closure was achieved at four weeks postoperatively. A year later, the patient is free of any similar lesions. Surgical excision of the tumor is still the benchmark of BLT treatment. It features the ability to confirm the diagnosis as well. Based on the extent of the lesions and the consequent skin defect, a multidisciplinary approach is strongly recommended. Due to the high recurrence rate and potential malignant transformation, a close follow-up is necessary.