This report focuses on a 55-year-old man of Afro-Caribbean origin who presented to a tertiary teaching hospital with a 30-year history of progressively enlarging lesions in his groin. The presence of the lesions was affecting his physical, sexual, social and emotional well-being. Surgical excision was performed and a histopathological diagnosis of giant cell condylomata was made.

INTRODUCTION
Giant condyloma acuminata (GCA), which was first described by Buschke and Löwenstein in 1925, is a rare variant of condyloma that is rapidly growing, fungating and locally invasive. Synonyms for this condition include, Buschke-Löwenstein tumour and giant malignant condyloma. The lesions are caused by human papillomavirus (HPV) and are usually benign and well-differentiated, although they can result in severe physical, social and psychological difficulties. The condition is rare in children but common in young adults (usually <50 years).
 
GCA is 3.5 times more common in males than females[1] and most cases occur on the glans penis. It is postulated that it is less common in men who have been circumcised. The most common differential diagnoses are squamous cell carcinoma and Bowenoid papillosis. Management of these lesions at the early stage is essential. Medical treatment is limited to inoperable lesions to arrest growth[2]. Surgical excision remains the optimum treatment modality. This special report focuses on a case of GCA that was successfully treated despite long-standing multiple symptoms.


CASE REPORT
A 55-year-old man of Afro-Caribbean origin presented to the authors' combined dermatology-plastic surgery clinic in a tertiary teaching hospital. The patient had a long history of 'growths' in his inguinoscrotal region. On further questioning he stated that the growths started about 30 years ago as tiny 'wart-type' lesions but had gradually increased in size and number in recent years. The patient's presenting complaints included increasingly severe discomfort on walking, heaviness, malodour, lower back pain and a 'dragging' sensation in his inguinal region. He stated that the lesions were itchy, painful and occasionally bled. In addition, the patient also reported difficulty in developing and maintaining relationships, lack of self-confidence, low self-esteem and an inability to perform sexual intercourse. His past medical history was unremarkable apart from hypertension, for which he was taking the appropriate medication.
 
On examination, the patient was found to have multiple, large, exophytic lesions in the groin, scrotum and shaft of the penis [Figs 1-2]. They were pedunculated with numerous satellite lesions in and around the inguinoscrotal region. Due to the extent of the lesion and the severity of the signs and symptoms it was decided to surgically excise the lesion. Consent was also obtained for skin grafting of the region to reconstruct the defect after excision, if required.  

Figure 1 - Giant condylomata acuminata (GCA) of the inguinal region on initial clinical presentation.

Figure 2 -  Lesions affecting the shaft of the penis.