and Angela J. Yoon1
Columbia University College of Dental Medicine and Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
A variety of papillary lesions affect the oral mucosa. In this section, we will focus on papillary lesions caused by various subtypes of human papillomavirus (HPV). HPV is a DNA virus that infects epithelial cells of the skin and mucosa resulting in solitary or multifocal epithelial lesions. Differentiating these lesions can be clinically difficult; in the following pages we present subtle clinical clues that can help. In some cases, histologic examination and HPV subtyping is needed to differentiate the lesions.
2.1 Verruca Vulgaris
Also known as the common skin wart. It is uncommon in mouth, but verruca vulgaris is very common on the skin, often occurring on the hands in children.
Papillary, exophytic, white growth. Vary in size, most often a few millimeters to 1 cm. Multiple lesions are not uncommon. Asymptomatic.
Viral – human papillomavirus (HPV), often as the result of auto-inoculation from cutaneous warts of the fingers. The associated HPV subtypes are that of the “low-risk” subtypes (HPV-2, HPV-4, and HPV-40).
Anywhere, common in the anterior aspects of the oral cavity (i.e., anterior gingiva, lips, anterior tongue) – site that are easily auto-inoculated by putting infected fingers in mouth.
Squamous papilloma, condyloma acuminatum, oral lesions of Heck disease, giant cell fibroma, and verruciform xanthoma.
Conservative surgical excision, recurrence unlikely but possible. Some lesions resolve spontaneously over time.
Verruca vulagris. White warty lesion of the fingertip and nail bed of a child
Verruca vulagris. White, raised, papillary growth of the ventral tongue
Examining the patient’s hands for cutaneous lesion may aid in diagnosis.