• This report is the first to describe a staged fractional electrosurgery approach, followed by a strategically delayed 3-week ALA-PDT course, for treating giant perianal condyloma. • The crucial 3-week period between electrosurgery and the start of PDT enabled inflammation to subside, thereby improving both the effectiveness of PDT and patient tolerance. • The combination of Fractionated Electrocoagulation and Delayed Photodynamic Therapy led to complete macroscopic clearance through electrosurgery and microscopic eradication of latent HPV infection via PDT. This approach resulted in no recurrence at the 12-month follow-up while preserving anal sphincter function. Giant perianal condyloma acuminatum poses significant clinical challenges due to its extensive lesions and high recurrence rates. Traditional treatments, like surgical excision, frequently result in considerable tissue damage and impaired anal function. This paper presents a case of a patient with a giant perianal mass successfully treated with an innovative combined approach involving staged electrocautery followed by delayed photodynamic therapy, leading to complete lesion clearance. This method offers an effective treatment paradigm for giant perianal condyloma acuminatum.
Zhang et al. (Wed,) studied this question.