Photo Derm Diagnosis: A perianal skin-coloured verrucous plaque in a 35-year-old female

A 35-year-old woman, married with six children was referred to the dermatology clinic of aleppo university hospital, syria with the chief complaint of erythematous painless papule around anus for 5-month. it gradually enlarged into a skin-colored (3x4 cm) verrucous plaque with some erosions without bleeding (figure 1). there was history of pruritus and discharge in that area. these lesions were clinically consistent with condyloma acuminata. rest of the history was insignificant except her father and brother had leukemia. general physical examination was normal with no evidence of systemic disease. serologic testing for viral hepatitis and syphilis was negative. histological examination of the plaque, showed full thickness keratinocyte dysplasia, with marked nuclear atypia and numerous mitotic figures (figures 2 and 3). immunohistopathology for hpv was negative.