Condyloma acuminatum (CA) caused by Human Papillomavirus (HPV) is the infection in the anogenital region mostly occurring as a sexually transmitted disease. The local activity of HPV expresses itself in the overgrowth of the epithelium of the affected tissues [
1-
3]. The prevalence of human papilloma virus is 10% in the world, mostly it affects women under the age of 35. The associated CA has the prevalence of 0.75–3% in Europe and 1% in the United States [
3]. One of the risk factors for CA development is an immune-compromised state [
3]. The progression of CA to a Buschke-Lowenstein tumor (BLT) occurs on very rare occasions. BLT known also as giant CA is a slowly growing cauliflower-like tumor associated with HPV types 6, 11, 16, and 18, but unlike simple condyloma, it is locally destructive and infiltrative. Due to its very low incidence rate, mainly sporadic single center experience is available in literature [
3,
4]. It is reported in the current literature that BLT incidence increased to 6.3 cases per year in the last decade worldwide [
3]. Giant condyloma acuminatum presents with a 2.7:1 male-to-female ratio, the mean age at presentation is 43.9 years. The most common presenting symptoms are perianal mass (47 percent), pain (32 percent), perianal abscess or fistula (32 percent), and bleeding (18 percent) [
5]. The disease, for which the most important treatment method is the surgical excision, differs from normal condyloma acuminatum cases with its high degree of malignancy. In 40-60% of condyloma acuminatum cases malignant transformation into invasive squamous carcinoma in particular for HPV types 16 and 18 is proved [
1-
3]. Foci of invasive carcinoma are noted in 50 percent of the reports, “carcinoma in situ” in 8 percent, and no invasion in 42 percent [
5]. Local invasion and local recurrence are the major source of morbidity in this disease. The disease is associated with high recurrence and mortality rates of, respectively, 67 and 21 percent [
3,
4,
6]. It is why complete surgical excision is the treatment of choice and often wide wounds are necessary to reach clear margins and prevent recurrence [
1,
4]. However widespread anodermal and epithelial condylomata excision rises the risk of scar formation and possible anal stenosis. But as a primarily applied treatment surgical excision has the highest success rate and the lowest risk of recurrence [
3,
6]. In limited lesions primary excision can be safely performed leaving wounds open to granulate while in more extensive lesions flap or skin graft coverage according to different techniques is preferable to decrease the length of recovery and minimize risk of severe anal stricture [
4]. Abdominoperineal resection should be performed for more extensive lesions with deep anorectal invasion, malignant transformation or malignant tumor recurrence. Recurrence of BLT is common. No sufficient data are available to recommend any medical treatment such as interferon, radiotherapy or chemotherapy, with all their limitations and side or adverse effects [
3,
7].
The authors present a case of a very extensive BLT treated with an S-plasty rotating and a bilateral house advancement flap with Burow’s triangles cuts respectively with good functional result.