When secondary syphilis is reliably recognizable

BACKGROUND: Condyloma lata is a manifestation of secondary syphilis that is underrecognized histopathologically, reported to mimic other entities, including squamous cell carcinoma. OBJECTIVE: To describe characteristic clinical and histopathologic features of condyloma lata. METHOD: A retrospective review was conducted of cases with histopathologic diagnoses of syphilis from January 2010 to February 12, 2025. The histopathologic findings were categorized as condyloma lata or other manifestations of secondary syphilis. RESULT: Of 28 syphilis cases, 12 patients (15 specimens) were diagnosed with condyloma lata. The average age was 36.8 years (range: 21-52), with an equal sex distribution. Twelve of 15 lesions were anogenital, and 3 were extragenital. Syphilis was included in the clinical diagnosis in only 50% of cases, and one oral lesion was initially misdiagnosed as squamous cell carcinoma. In 25% (3/12) of the cases, the patient had other cutaneous manifestations of secondary syphilis. All condyloma lata lesions showed a consistent constellation of findings such as follows: eroded dome-shaped or verrucous plaque with bulbous, jagged, and/or irregular pseudoepitheliomatous hyperplasia, a dense or lichenoid lymphoplasmacytic infiltrate, prominent neutrophilic exocytosis associated with small spongiotic vesicles, and numerous spirochetes concentrated in the lower third of the epidermis. The remaining 16 patients (19 specimens) with noncondyloma lata secondary syphilis demonstrated considerable histopathologic variability. LIMITATION: Retrospective design with a small sample size. CONCLUSION: Condyloma lata exhibits consistent, reliable, reproducible histopathologic features. Recognition of these features can prevent misdiagnosis, particularly at extragenital sites, where syphilis may be clinically unsuspected.