Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2025;15(1):4655 1 Dermoscopic Features of Anogenital Verrucous Carcinoma Enrico Zelin1, Giuseppe Stinco2, Marco Turina3, Enzo Errichetti2 1 Institute of Dermatology, ‘Santa Maria della Misericordia University Hospital’, Udine, Italy 2 Institute of Dermatology, Department of Medicine, University of Udine, Udine, Italy 3 Department of Pathology, ‘Santa Maria della Misericordia Hospital’, Udine, Italy Key words: Dermoscopy, Anogenital Verrucous Carcinoma, Squamous Cell Carcinoma, Anogenital Lesions Citation: Zelin E, Stinco G, Turina M, Errichetti E. Dermoscopic Features of Anogenital Verrucous Carcinoma. Dermatol Pract Concept. 2025;15(1):4655. DOI: https://doi.org/10.5826/dpc.1501a4655 Accepted: August 19, 2024; Published: January 2025 Copyright: ©2024 Zelin et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Enrico Zelin, Institute of Dermatology, ‘Santa Maria della Misericordia University Hospital’, Udine, Italy. Phone number: +390432559820. E-mail: enrico.zelin@gmail.com Introduction Anogenital verrucous carcinoma (aVC) represents a rare subtype of well-differentiated mucocutaneous squamous cell carcinoma often related to human papillomavirus infection. It manifests as a slow-growing, warty lesion, usually show- ing ulceration [1]. Due to similarities in clinical presentation, aVC can be misdiagnosed as various lesions, such as sebor- rheic keratosis, genital wart, chancre (primary syphilis), or condyloma latum (secondary syphilis), leading to diagnostic delays. This retrospective observational monocentric study aims to characterize dermoscopic findings of aVC, compar- ing it with the main clinical mimickers. Case Presentation We selected consecutive patients histologically diagnosed with aVC for whom high-quality clinical and dermoscopic (polarized) iconography was available. All images were evaluated by 2 experienced dermoscopists (EE and EZ) in agreement for the presence of items defined according to the International Dermoscopy Society consensus documents [2]. A total of 6 patients (4 males and 2 females, mean age 65.3 years, range 45-80 years) were included, diagnosed with 6 aVCs, all appearing as poorly defined, verrucous lesions (mean diameter 23 mm, range: 8-40 mm), some of them also showing ulceration (Figure 1 A, C, and E). In general, the most common dermoscopic findings (Figure 1, B, D, and F) included white clods on a reddish/pinkish background (6/6; 100%), white structureless areas (5/6; 83%), and a polylob- ular appearance (5/6; 83%). In 2 cases, a white cerebriform pattern characterized by thick, curved, white lines on a red background was observed. Vessel morphology was mainly coiled/glomerular (6/6, 100%), followed by looped/hairpin (3/6, 50%) and dotted (2/6, 33%). In half of the cases, we observed polymorphous vessels (i.e., more than one vessel shape), while vascular distribution pattern was unspecific in all instances. Table 1 summarizes all analytical data. 2 Research Letter | Dermatol Pract Concept. 2025;15(1):4655 Figure 1. Clinical appearance of (A) penile and (E) vulvar verrucous carcinoma, with corresponding dermoscopic presentation and histopathologic picture. Polarized dermoscopy (×10 magnification) reveals a (B, D, F) polylobular appearance, white clods on a red/pinkish background (black arrows), white structureless areas (black stars [B, D]), white cerebriform pattern (white star [F]), coiled/glomerular vessels (black circles [D]), and looped/hairpin vessels (white circles [F]). Histopathology reveals a squamous cell carcinoma, showing a dysplastic epithelium with (G) abundant keratinization and (H) keratin pearls, (H&E, ×40 magnification). Table 1. Dermoscopic features of anogenital verrucous carcinoma from our analysis (total number of lesions = 6), compared with its most common differential diagnoses: seborrheic keratosis, genital wart, chancre (primary syphilis), and condyloma latum (secondary syphilis). Anogenital Verrucous Carcinoma (N = 6) Seborrheic Keratosis [3] Genital Wart [3,4] Chancre [5] (Primary Syphilis) Condyloma Latum (Secondary Syphilis) [5,6] Dermoscopic structures White clods on a red/pink background 6 (100%) Milia-like cysts (white clods), cerebriform pattern, fingerprint- like structures, sharp demarcation, moth eaten border Polylobular appearance (mosaic, knob-like or finger-like pattern) Reddish/whitish central area and peripheral whitish annular border Follicular plugs (common); scales, white globules and focal white/brown structureless areas (less common) White structureless areas 5 (83%) White thick lines on a red/pink background (white cerebriform pattern) 2 (33%) Polylobular appearance 5 (83%) Vessels Dotted 2 (33%) Mostly looped (hairpin), coiled (glomerular), dotted, linear irregular, and comma vessels Mostly coiled (glomerular), looped (hairpin), and dotted Different morphologies (mostly linear irregular / serpentine) Dotted or glomerularCoiled/glomerular 6 (100%) Looped/hairpin 3 (50%) Polymorphous vessels 3 (50%) Unspecific distribution 6 (100%) Uniform distribution Uniform or unspecific distribution Unspecific distribution Uniform or clustered distribution Research Letter | Dermatol Pract Concept. 2025;15(1):4655 3 Conclusions In analyzing the main differential diagnoses, some morpho- logical features are helpful to distinguish them from aVC. In- deed, anogenital seborrheic keratoses can present milia-like cysts (bright gray clods), but are generally characterized by a sharply demarcated border, while aVC is usually poorly defined [3]. Genital warts classically present a polylobular appearance, with each lobule containing a dotted, coiled, or hairpin vessel; conversely, in aVC, vessels are generally located around white clods [3,4]. Syphilitic chancre typi- cally shows a reddish or whitish central area (erosion) with a peripheral whitish annular border and vessels of various morphologies (mostly linear irregular/serpentine), thus being rather different from aVC on dermoscopy [5]. On the other hand, condyloma lata share some dermoscopic features with aVC (dotted or glomerular vessels, white structureless areas, and less commonly white clods corresponding to follicular plugs) [5,6]. However, condyloma lata are often multiple and accompanied by positive syphilitic laboratory tests. Our study highlights that a polylobular appearance and “white findings” resulting from keratinization (ie, white struc- tureless areas and white clods histologically corresponding to hyperkeratosis and ‘keratin pearls’, respectively (Figure 1, G and H) are the most prominent dermoscopic indicators of aVC, as they are not typically seen in its mimickers. The main limitations of this study include the small sample size, resulting from the rarity of aVC, the retrospective design, and the lack of control group. Therefore, further analyses are needed to confirm our preliminary observations. Ethics Statement: The patients in this manuscript have given written informed consent to publication of their case details. References 1. Fawaz B, Vieira C, Decker A, Lawrence N. Surgical treatment of ver- rucous carcinoma: a review. J Dermatolog Treat. 2022;33(4):1811-5. DOI:10.1080/09546634.2021.1914312. PMID: 33849379. 2. Kittler H, Marghoob AA, Argenziano G, et al. 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