Review Question - QID 214816

A 40-year-old man comes to the primary care clinic complaining of anal lesions that have been present for a few months. He states that they occasionally itch but are otherwise asymptomatic. He is worried because they continue to grow. His son and daughter had “bumps” on their skin from a virus that eventually went away on their own. The patient wonders if he could have caught this from them. The patient is currently sexually active with multiple women. His condom use is inconsistent. He was screened for sexually transmitted infections a few days ago, but the results are still pending. The patient has well-managed type 2 diabetes currently treated with metformin. His temperature is 98.6°F (37.0°C), blood pressure is 138/88 mmHg, pulse is 65/min, and respirations are 12/min. Figure A shows an image of the patient’s anal skin exam. Which of the following is the most likely diagnosis?