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Figure 1 In circumscribed lesions, surgery is performed using infiltration anesthesia applied subepidermally. Separation of warts is achieved, and individual lesions can be removed by scissor-snip excision, curettage, electrocautery, or C02 laser. Infiltration anesthesia may be performed on the penile shaft, foreskin, and glans penis. Infiltration anesthesia of the perianal and the vulvar area is best performed with adrenalin as an adjuvant to promote hemostasis. Separation of individual warts will facilitate an accurate removal of the warts and sparing of uninvolved skin bridges. Application of EMLA cream before infiltration anesthesia helps minimize pain from the needle stick.