Cauliflower Bottom

A 66 year-old man previously investigated in June 2007 for anaemia presented again 4 months later to Accident & Emergency with rectal bleeding requiring another transfusion. Examination revealed a large malignant-looking wart (cauliflower lesion) which he claimed had arisen in the last week. Subsequent biopsy identified this as an unusual bowenoid papillary squamous cell carcinoma with vascular invasion. Bowenoid papulosis (BP) and condyloma accuminata are both HPV-associated conditions causing epidermal lesions with epithelial hyperplasia and dysplasia. Malignant change occurs in under 5%.