Abstract Giant condyloma acuminatum, also known as BuschkeLöwenstein tumor (BLT) is a very rare sexually transmitted disease that affects the ano-genital region. BLT is a slow growing cauliflower-like tumor, but unlike simple condyloma, it is locally aggressive and destructive, malignant transformation occuring in 40-60% of cases. We present a case of perianal carcinomatous BLT and discuss some controversies about the nature and treatment of this