“…221 Predisposing factors also include poor hygiene, trauma, and viral infections (HPV 16). [222][223][224][225] It clinically appears as a single or, less often, multiple 222,223 hard and conical keratotic outgrowth of variable size, yellowish or whitish in color, with a bulging erythematous base (Fig 3). 223,226 Histologically, changes typical of different underlying conditions, including benign epidermal J AM ACAD DERMATOL hyperplasia, warts, keratoacanthoma, hemangioma, and in situ or invasive carcinomas (SCC or verrucous carcinoma), may be observed.…”