PMC10343114_01
(a) An ulcerated plaque with surrounding multiple asymptomatic discrete, rounded, hyperpigmented verrucous papules and plaques over the perianal region. (b) Skin biopsy shows papillomatosis, epithelial hyperplasia, and loss of polarity of epithelium with the pathognomonic "windblown" appearance of atypical keratinocytes (H and E, x10). (c) Atypical keratinocytes and multiple atypical mitotic figures (H and E, x40). (d) Excisional removal of the lesion with skin grafting
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F1
Cutaneous examination revealed a single large ulcerated plaque of size 2 cm x 3 cm present over the perianal region [Figure 1a]. A skin biopsy from the plaque showed papillomatosis, epithelial hyperplasia, and loss of polarity of the epithelium [Figure 1b]. The pathognomonic "windblown" appearance of atypical keratinocytes and multiple atypical mitotic figures were better appreciated on high power [Figure 1c]. An inferior gluteal artery-based muscle pedicle flap was carried out and the ulcerative growth was removed en masse [Figure 1d].