Peer Reviewed

Photo Essay

An Atlas of Lumps and Bumps, Part 2

Alexander K. C. Leung, MD1,2
—Series Editor • Benjamin Barankin, MD3 • Joseph M. Lam, MD4 • Kin Fon Leong, MD5

1Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
2Alberta Children’s Hospital, Calgary, Alberta, Canada
3Toronto Dermatology Centre, Toronto, Ontario, Canada
4Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
5Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia

Leung AKC, Barankin B, Lam JM, Leong KF. An atlas of lumps and bumps, part 2. Consultant. 2021;61(3):e9-e11. doi:10.25270/con.2021.01.00011

Dr Leung is the series editor. He was not involved with the handling of this paper, which was sent out for external peer review.

Alexander K. C. Leung, MD, #200, 233 16th Ave NW, Calgary, AB T2M 0H5, Canada (

This article is part 2 of a series describing and differentiating dermatologic lumps and bumps. To access previously published articles in the series, visit


Genital Warts

Genital warts (also known as condylomata acuminata or anogenital warts) are the most common clinical manifestations of genital human papilloma virus (HPV) infections.1,2 It is estimated that 1% of sexually active individuals aged 16 to 35 years have clinically evident genital warts.2  Men are more commonly affected.1 Approximately 90% of genital warts are caused by HPV 6 and HPV 11.1,2 HPV strains 1, 2, 3, 4, 16, 18, 40, 42, 43, 44, 54, 70, 72, and 81 account for the rest.2  In adults, genital HPV infection is predominately transmitted by penetrative intercourse and less commonly by oral sex, skin-to-skin transmission, and fomites.1-3 In children, HPV infection may result from sexual abuse, vertical transmission, autoinoculation, heteroinoculation, and transmission via fomites.2,4 

Genital warts are usually asymptomatic but may at times cause discomfort, itching, burning, bleeding, and pain.1-3 They are most commonly found on the external genitalia. In men, genital warts are usually located on the frenulum, glans penis, inner surface of the prepuce, coronal sulcus, and scrotum.1,2,5 In women, genital warts may be found in the vagina, on the vulva, and on the cervix.5 There is a predilection for the smooth, moist mucosa of the posterior vaginal introitus and the labia.1 In both sexes, genital warts can be found in or around the anus. Genital warts can occur separately or in clusters.2,3 They can be pedunculated or sessile.1,2

Genital warts typically present as small, discrete, soft, smooth, pearly, dome-shaped papules at onset.2,6 With time, the papules may coalesce into plaques.2 Lesions may be flat, papular, filiform, exophytic, papillomatous, verrucous, hyperkeratotic, cerebriform, fungating, or cauliflower-like (Figures 1 to 12).1,2,5-7 The color varies and may be flesh-colored, light and pearly, whitish, pink, erythematous, gray, brown, violaceous, dark purple, or hyperpigmented.2,5,8 Buschke-Löwenstein tumor, also called giant condylomata acuminatum, is a verrucous carcinoma in the anogenital and perianal areas, often associated with HPV 6 and HPV 11.9 

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The diagnosis is mainly clinical, based on the history of venereal exposure and physical findings.  Dermatoscopy and in-vivo reflectance confocal microscopy help to increase the diagnostic accuracy. The dermoscopic features may vary from finger-like to knob-like patterns, and the vascular pattern may vary from glomerular, to hairpin, to dotted. Skin biopsy is warranted if the diagnosis is in doubt.


  1. Leung AKC, Kellner JD, Davies HD. Genital infection with human papillomavirus in adolescents. Adv Ther. 2005;22(3):187-197. doi:10.1007/BF02849928
  2. Leung AKC, Barankin B, Leong KF, Hon KL. Penile warts: an update on their evaluation and management. Drugs Context. 2018;7:212563. doi:10.7573/dic.212563
  3. Leslie SW, Sajjad H, Kumar S. Genital warts. In: StatPearls. Treasure Island (FL): StatPearls Publishing; November 20, 2020.
  4. Costa-Silva M, Azevedo F, Lisboa C. Anogenital warts in children: analysis of a cohort of 34 prepubertal children. Pediatr Dermatol. 2018;35(5):e325-e327. doi:10.1111/pde.13543
  5. Grennan D. Genital Warts. JAMA. 2019;321(5):520. doi:10.1001/jama.2018.20181
  6. Karnes JB, Usatine RP. Management of external genital warts. Am Fam Physician. 2014;90(5):312-318.
  7. Shimizu A, Hattori M, Kaira K, Ishikawa O. Keratotic condyloma acuminatum. J Dermatol. 2016;43(6):716-717. doi:10.1111/1346-8138.13266
  8. Lopaschuk CC. New approach to managing genital warts. Can Fam Physician. 2013;59(7):731-736.
  9. Saikaly LE, Saikaly SK, Norman R. Buschke-Loewenstein Tumor: A Case Report and Advocacy for Human Papillomavirus Vaccination. Cureus. 2020;12(10):e10789. doi:10.7759/cureus.10789