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Flat Warts — SCE Dermatology MCQ

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HardCutaneous InfectionFlat WartsSCE Dermatology

A young adult from a consanguineous family has widespread flat wart-like lesions from childhood and multiple sun-exposed cutaneous SCCs. HIV testing is negative. Which inherited disorder is most likely?

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Correct answer: E — Epidermodysplasia verruciformis caused by impaired control of beta-papillomaviruses

E is correct. Epidermodysplasia verruciformis causes selective susceptibility to beta-papillomaviruses, widespread pityriasis-versicolor-like or flat wart-like lesions, and a substantial risk of UV-exposed cutaneous SCC. Autosomal-recessive classic disease commonly involves TMC6 or TMC8. WHIM, GATA2 and DOCK8 disorders can cause severe HPV disease, but their haematological, bacterial, mycobacterial, atopic or broader viral phenotypes provide distinguishing clues. Management centres on rigorous photoprotection, surveillance and early treatment of dysplasia or cancer; eliminating visible warts does not remove the inherited cancer risk.

Reference: GeneReviews: epidermodysplasia verruciformis: https://www.ncbi.nlm.nih.gov/books/NBK189880/