Extragenital HPV Condyloma Appeared on the Neck of an Immunocompetent Man
A case from New York adds an unusual anatomic site to the clinical range of human papillomavirus infection. In 2025, a heterosexual man in his 40s with an unremarkable medical history sought care for a growth on the right lateral neck that had been present for a year and had enlarged over time. Examination showed six clustered brown papules with a verrucous-to-mamillated surface. The appearance initially fit more common dermatologic diagnoses, including inflamed seborrheic keratoses and verruca vulgaris, and the lesion was treated first with cryotherapy. Temporary clearing followed, but recurrence 11 months later made tissue diagnosis necessary.
The biopsy changed the clinical frame. Histopathology showed papillated epidermal hyperplasia, hypergranulosis, compact orthokeratosis, and dilated blood vessels in the papillary dermis. In situ hybridization identified HPV types 6 and 11. Sexual health screening was unrevealing: tests for gonorrhea, chlamydia, syphilis, and HIV were negative. Complete blood count and comprehensive metabolic panel remained within reference limits, and immunologic screening showed only a low-titer positive antinuclear antibody at 1:80, with normal IgA, IgG, and IgM levels. In a patient without known immunodeficiency, the result narrows the usual assumptions about where these low-risk HPV types can persist and how they may present in skin outside the anogenital region.
The bedside implication is immediate. A persistent, wartlike lesion on the neck is not automatically a benign keratosis, and it is not always ordinary verruca vulgaris. Tissue sampling becomes more than a confirmatory step when the lesion recurs after destructive treatment or when its behavior does not match the expected course of a routine cutaneous wart. In this case, biopsy and HPV typing revealed a diagnosis that would likely have been missed if the lesion had been managed repeatedly as a nonspecific verrucous growth.
Low-Risk HPV Types 6 and 11 Reached an Atypical Cutaneous Site
HPV types 6 and 11 are classically linked to condylomata acuminata and account for most anogenital warts. Their biologic preference for mucosal epithelium has shaped routine teaching for years, which is why an isolated neck lesion in an immunocompetent adult stands out. Extragenital condylomas have been described before, but the published pattern has favored children, persons with HIV or other forms of immunosuppression, men who have sex with men, or patients with concurrent anogenital disease. A report of cutaneous HPV type 6 without genital involvement has appeared previously, yet that patient had HIV. The present case removes that familiar explanatory scaffold.
Several transmission routes remain plausible. Autoinoculation could seed virus from one body site to another. Fomites and direct skin-to-skin contact may transfer viral particles to cutaneous tissue. Vertical transmission has also been proposed in the broader HPV literature, although the route cannot be proven in an individual adult case. Each hypothesis fits the biology imperfectly, but together they reinforce a larger point: low-risk HPV can behave outside the anatomic script clinicians expect. Viral tropism is not absolute, and local epithelial vulnerability, microtrauma, and inoculation history may matter more than convention suggests.
This case also sits within the broader head and neck HPV discussion. The region is already recognized as a site where HPV can persist, and high-risk types such as HPV 16 dominate the pathogenesis of many oropharyngeal squamous cell carcinomas. Low-risk types 6 and 11 are not the drivers of that malignant pathway, yet their ability to infect nonanogenital skin raises a different diagnostic issue. A verrucous lesion on the neck can represent a viral process even when the patient is immunocompetent and lacks genital disease. Once the lesion is persistent or atypical, morphology alone is not enough.
The laboratory limitation in this report is straightforward. In situ hybridization did not distinguish between HPV 6 and HPV 11 individually, so the lesion was identified as positive for both types rather than assigned to one genotype with complete certainty. Even with that limitation, the case remains clinically meaningful because it documents extragenital condyloma in an immunocompetent adult without concurrent anogenital involvement. That combination is unusual enough to change the threshold for biopsy in similar presentations.
In practical terms, dermatologists, infectious diseases clinicians, and primary care physicians should keep HPV in the differential when a verrucous lesion on the neck, trunk, or other cutaneous site behaves like a wart but does not resolve as expected. Histology and HPV typing can prevent prolonged empiric treatment and reduce misclassification of a lesion that is biologically distinct from common seborrheic keratosis or ordinary verruca vulgaris. For patients, the diagnosis also avoids unnecessary speculation about occult systemic disease when standard screening is unrevealing.
The case does not define how often this presentation occurs, and it does not establish a population-level transmission pattern. It does, however, show that HPV-related condylomas can appear at nonanogenital cutaneous sites even in hosts without immunosuppression. When a wartlike lesion recurs after cryotherapy or persists beyond the usual timeline, biopsy is the step that changes management and clarifies the diagnosis.