Oral mucosal wart - Oral Mucosal Lesion
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
B07.8 – Other viral warts
402908003 – Oral wart
Differential Diagnosis & Pitfalls
- 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, 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.
- 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 and is 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 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.
- Oral florid papillomatosis.
- Oral squamous cell carcinoma.