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Oral mucosal wart - Oral Mucosal Lesion
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Oral mucosal wart - Oral Mucosal Lesion

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Contributors: Christine Hunt MD, Sylvia Hsu MD, Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc
Other Resources UpToDate PubMed

Synopsis

Oral mucosal warts, also known as papillomas, appear as asymptomatic, small, soft, pink or white, slightly elevated papules and plaques on the buccal, gingival, or labial mucosa, tongue, or hard palate. They grow in size over weeks to months. They are caused by human papillomavirus (HPV). More than 40 HPV types can infect the mucosa. The virus infects epithelial cells, where it 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 generally appear 1 to 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.

Verruca vulgaris is associated with HPV types 2 and 4. In HIV-infected individuals and other immunocompromised patients, 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 to be 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's disease, also known as focal epithelial hyperplasia, which consists of multiple (and, 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 who are of South American Indian, Greenlander Eskimo, or South African descent. 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

  • Common warts and squamous papillomas – These may look similar but generally are smaller in size.
  • Verrucous leukoplakia, early verrucous carcinoma, and 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, is caused by tobacco smoking, particularly pipe smoking, and may cause changes in the oral mucosa of the palate that are reversible: they will disappear 2 to 4 weeks after cessation of smoking. Continuation of smoking, however, can cause them to change into homogeneous leukoplakias that may no longer be reversible, and they may turn into carcinoma.
  • Frictional keratosis
  • 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. Lesions are strongly associated with Epstein-Barr virus infection.
  • White sponge nevus 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.
  • Verruciform xanthoma has a typical histology.
  • Sialadenoma papilliferum occurs almost exclusively on the palate, and the biopsy is diagnostic.
  • Secondary syphilis

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References

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Last Updated: 10/30/2018
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Oral mucosal wart - Oral Mucosal Lesion
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Oral mucosal wart : Oral mucosa, Oral papule, Oral white plaque
Clinical image of Oral mucosal wart
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