Large, Chronic, Perineal Low-Grade Intraepithelial Lesion in an Immunocompetent Patient: A Case Report

Condyloma acuminatum is a benign anogenital lesion that can vary in presentation from incidental findings to large, clinically significant masses. We present a case of a 53-year-old male with a medical history notable for obesity (BMI = 36.7 kg/m²) and a 20-pack-year smoking history. Additionally, the patient had a six-month history of a progressively enlarging perineal lesion identified incidentally during a routine screening colonoscopy. Examination revealed a dominant exophytic perineal mass measuring approximately 6 × 8 cm, along with three additional satellite lesions measuring approximately 2 × 2 cm each. The patient underwent surgical excision of all lesions, which were left to heal by secondary intention. Histopathologic evaluation demonstrated a low-grade squamous intraepithelial lesion consistent with condyloma acuminatum, with negative margins and no evidence of high-grade dysplasia or malignancy. Postoperative management included local wound care, nutritional optimization with high-protein intake and vitamin supplementation, and close clinical follow-up. At the one-week evaluation, the wounds demonstrated appropriate healing without evidence of infection. This case highlights the importance of thorough perineal examination, histopathologic confirmation of large lesions, and optimization of modifiable risk factors to support postoperative recovery.