Patient: Hi,I had a bump on my penis which my GP in the UK said could be a wart and wasnt sure and told me to go see a sexual health clinic, I then visited two clinics and the nurse there said it did not look like a wart and said it is possibly a cyst or molluscum.The second nurse checked the lesion with a light and said it does not appear or behave like a wart and then ensured me it was a variation of molluscum.A few days after the freezing the skin around it turned black and swelled up as shown in the pic, this slowly dissapeared and the lesion went away.Does this sound like a molluscum/wart or a cyst, and would the diagnosis of it not being a wart be correct?I have attached 3 photos of the lesion, since then it has now become pink and is healingI would appreciate your opinionThanks
Doctor: Hello,Thanks for the query to ATD for an opinion,This was indeed a verrucae wart and not a molluscum variation s imply because it was skin coloured and had frayed borders typical of a verrucae wart and also it was an isolated lesion. Molluscum is usually a smooth bump which is shiny and not skin coloured and most often with a dimple or depression in the centre and moreover it rarely manifests as a singular isolated lesion.The typical swelling of the lesion and turning darker is more indicative of a wart with increased keratinization and melanin deposition, unlike a molluscum. Cryotherapy has been rightly advocated and applied. The third picture depicts a healthy granulation tissue at the base of the lesion after the lesion has freeze died and shed off. The best form of diagnosis would have been a punch biopsy earlier and then histopathologic examination which would have given a definitive diagnosis.However, the treatment for both wart and molluscum remains cryotherapy or laser and hence as seen by the healing lesion, which appears healthy at base, you stand treated and the lesion shall completely heal in a week or so.I hope I have answered your query in detail,Wishing you speedy recovery,Regards
Comments / Follow Ups
Patient: Thankyou for the information. I am really baffled as the two seperate sexual health clinics ensured me it was molluscum, and not a wart.
If it is a verrucae wart, does this mean it is a sexually transmitted wart or can it be a common wart?
Can this wart infection ever re-occur as this single bump was there for over a year?
Doctor: This as has been for a year long it is more likely to be associated with HPV strain 6 or 8 , though there are 140 + strains known and identified. There is all possibility that it may have been sexually contracted.
It is difficult to talk about the recurrence but it has been documented, yes.
Warts come in different shapes and sizes, this one has an appearance of verrucous like wart with frayed margins and irregular growth, unlike molluscum completely.
Patient: two seperate nurses thoroughly checked it with a light and magnifying glass and said even though it appears to be a wart, it is not a wart and also touched it and felt it to confirm this. there is also another small lesion around my penis which looks more like molluscum and the 2 seperate clinics had said that this one is just another variation of the molluscum.
I am just quite confused by the diagnosis they have made and the diagnosis you have made doctor?
As I have been quite skeptical of this lesion for a while can their diagnosis have been incorrect?
in that case the most confirmatory would be a biopsy of the lesion and then a histopathological exam and a future to isolate either a hpv virus (wart) or a molluscum virus. They can be differentiated during the exam and confirmed diagnosis may be made.
Patient: Hi there,
I contacted the clinic today if it were possible to do a biopsy, the nurse told me the fact that I visited two seperate clinics and had it checked by experienced specialists in this area who both diagnosed it as molluscum, means that it rules out it being a wart and there is no need for a biopsy.
Doctor: okay nice to hear that. Local examination is always superior .