Surgical management of perianal giant condyloma acuminatum (Buschke-Löwenstein tumor). Report of three cases.

Giant condyloma acuminatum (GCA) is a slow-growing, large, cauliflower-like tumor located in the anogenital region. This tumor has a locally destructive behavior, a high recurrence rate and occasional transformation to squamous cell carcinoma. Risk factors include anoreceptive intercourse, HIV and immunosuppression. There is no general agreement on the choice of treatment for this tumor. Wide radical excision with plastic reconstruction of skin defects seems to be the best treatment, while adjuvant therapies, such as radiotherapy and immunotherapy, may achieve good results, but their effectiveness is still uncertain. Loop colostomy, considered mandatory by several authors in order to minimize wound contamination risk, does not appear to be necessary (except in cases of anal canal involvement beyond the dentate line) if a combination of bowel cleansing, non-fiber diet and loperamide can be administered. The authors report 3 cases of perianal GCA treated by radical local excision and reconstruction by S-plasty grafts, without performing loop colostomy