Treatment modalities for genital warts

Surgical scissor excision (Grade B). One of the oldest documented treatments for the removal of genital warts, surgical excision was considered for many years to be the primary available option. It involves the physical removal of diseased tissue from the body with scissors or a scalpel, followed by suturing the remaining healthy skin together. It is associated with up to a 72-percent clearance rate, which is evident immediately and often persisting over a year later. Although now considered to be somewhat outdated, this treatment option is still suitable for very large lesions that may be causing obstruction and are ineligible or unresponsive to other forms of treatment. Examples include lesions involving the urethral meatus.
Additionally, surgical excision remains the optimal procedure for the removal of neoplastic lesions suspected of malignant progression, which must be submitted for further histopathological examination. Surgical removal of large lesions is a painful process, which frequently results in bleeding and scar formation. The administration of local or general anesthesia is commonly recommended.
A recent and considerably more sophisticated surgical excision procedure for the treatment of genital warts is Mohs surgery. Although intended predominantly for cutaneous carcinomas, Mohs is a highly specialized technique in which the skin is removed in very thin layers and subject to immediate microscopic analysis for traces of pathology. In the continued presence of viral cell features, additional skin slices will be removed until the entire wart is excised and only healthy tissue remains. The obvious benefit of this type of surgery is that it allows for the maximal preservation of healthy skin, resulting in minimal scar formation. However, it is a significantly more expensive and involved process and is only considered when the cosmetic appearance of the removal process is of significant concern.

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