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Oral mucosal wart - Oral Mucosal Lesion
Other Resources UpToDate PubMed

Oral mucosal wart - Oral Mucosal Lesion

Contributors: Rajini Murthy MD, Christine Hunt MD, Sylvia Hsu MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Oral mucosal warts, also known as papillomas, are asymptomatic small, soft, pink or white, slightly elevated papules and plaques on the buccal, gingival, or labial mucosa, tongue, or hard palate. They grow over the span of weeks to months. They are caused by human papillomavirus (HPV). More than 40 HPV types can infect the mucosa. The virus infects epithelial cells and can exist as a long-term latent infection that can reactivate or persist actively, even subclinically. Oral warts may result from digital or oral-genital sexual transmission. Condyloma acuminata are sexually transmitted and generally appear 1-3 months after exposure to an infected partner and present in multiple forms in the oral cavity.

Different HPV types have markedly different oncogenic potentials. High-risk HPV types include HPV-16, -18, -31, -33, and -45. Infections with HPV-6 and -11 are frequently detected in oral mucosal warts and occur commonly in benign or low-grade intraepithelial neoplasms but are very rarely associated with the development of malignancies.

Condyloma acuminata are caused by HPV-6, -11, -16, and -18.

Verruca vulgaris is associated with HPV types 2 and 4. In HIV-infected and other immunocompromised individuals, oral warts are frequently detected and may contain unusual HPV types, such as HPV-7, -71, -72, and -73.

Bowenoid papulosis has been reported in the mouth. Bowenoid papulosis may be considered as a transitional state between condyloma acuminatum (similar clinically) and Bowen disease (squamous cell carcinoma in situ) (similar histologically). Careful observation for recurrence and for the possibility of invasive or in situ malignancy is warranted.

A subtype of oral warts is Heck disease, also known as focal epithelial hyperplasia, which consists of multiple (or, rarely, single) smooth, white-to-pink papules found on the tongue, lips, palate, and floor of the mouth as well as the gingival, buccal, and labial mucosa. It is relatively common in children of South American Indian, Greenlander Eskimo, or South African descent. The lesions may clear spontaneously. It is strongly associated with HPV-13 and -32.

Related topic: genital wart

Codes

ICD10CM:
B07.8 – Other viral warts

SNOMEDCT:
402908003 – Oral wart

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Verrucous Leukoplakia, early Verrucous carcinoma, and Oral squamous cell carcinoma must be considered – A biopsy is essential to rule these out.
  • Proliferative verrucous leukoplakia, a premalignant condition, consists of white-to-pink papules and plaques. It characteristically does not contain HPV DNA and has a high risk of progression to metastatic squamous cell cancer.
  • Smoker's palate, or tobacco-induced keratosis, caused by tobacco smoking, especially pipe smoking, may cause changes in the oral mucosa of the palate; lesions will disappear 2-4 weeks after cessation of smoking. Smoking continuance; however, can cause them to change into homogeneous leukoplakias that may no longer be reversible, and they may turn into carcinoma.
  • Oral frictional hyperkeratosis
  • Oral hairy leukoplakia is almost always located on the border of the tongue and has a shaggy appearance. It is seen mostly in immunocompromised individuals and is strongly associated with Epstein-Barr virus infection.
  • White sponge nevus of the oral mucosa is a rare autosomal dominant disorder with symmetrical linear, white, flat-topped, and sometimes verrucous plaques in the mouth. It is most common on the buccal mucosa and tongue.
  • Verruciform xanthoma has a typical histology.
  • Sialadenoma papilliferum occurs almost exclusively on the palate, and the biopsy is diagnostic.
  • Secondary syphilis
  • Primary syphilis
  • Verrucous carcinoma
  • Oral squamous cell carcinoma

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      Last Reviewed:08/09/2022
      Last Updated:09/06/2022
      Copyright © 2024 VisualDx®. All rights reserved.
      Oral mucosal wart - Oral Mucosal Lesion
      A medical illustration showing key findings of Oral mucosal wart
      Clinical image of Oral mucosal wart - imageId=1883067. Click to open in gallery.  caption: 'A moist, pink and whitish, verrucous papule on the labial mucosa.'
      A moist, pink and whitish, verrucous papule on the labial mucosa.
      Copyright © 2024 VisualDx®. All rights reserved.