CASE

A 26-year-old man self-referred himself to the dermatology clinic for evaluation of “genital warts” that had not responded to OTC wart medication. The lesions had been present for several years unchanged, caused no symptoms, and had never appeared in any other locations. The patient had been heterosexually monogamous during this entire time and claimed to be otherwise healthy, with no recent behavior that elevated his risk for HIV. His female sexual partner had seen these lesions and was concerned that they represented warts; she had had twice yearly Pap smears and pelvic examinations, which had shown no signs of human papillomavirus-caused lesions.

Inspection of the penis showed a band of uniformly pigmented, 1- to 2-mm, notably soft, fleshy papules confined to the coronal sulcus, distributed circumferentially (see Figure 1). The lesion surface was smooth and shiny. No lesions were seen elsewhere on the penis, scrotum, or suprapubic or crural areas.






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