Papillary Growths

Question 1

Papillary Growths

Answer 1

HPV Related
◦ Squamous Papilloma
◦ Verrucous Vulgaris
◦ Condyloma
◦ Multifocal Epithelial Hyperplasia (Heck’s Disease)
Inflammatory Papillary Hyperplasia
Verrucous Carcinoma (Smokeless-Tobacco)

Question 2

Squamous Papilloma

Answer 2

Caused by HUMAN PAPILLOMAVIRUS (Over 100 types)
◦ Intraorally is commonly HPV 6 and 11
Occurs on soft palate, tongue and labial mucosa
◦ UNCOMMON on gingiva
Pink or white papillary or pedunculated nodule
Represent about 8% of soft tissue masses in children
TX: Excisional Biopsy, use caution with viral particle and laser
Rarely reoccur, unless reinoculated and different location
Vaccine will now prevent HPV 6, 11, 16 and 18
Multiple lesions may be verruca vulgaris or condyloma acuminatum

Question 3

Verruca Vulgaris

Answer 3

Most commonly found on skin, but can occur intraorally
◦ Hands and face and most common, check these sources
◦ Oral sites are lip vermillion, labial mucosa or anterior aspect of
tongue
Caused by HPV2
White to pink stippled or papillary nodules, usually multiple
vs single nodules
TX: Excisional biopsy to confirm if oral, refer to dermatology,
primary care if located on skin

Question 4

Multifocal Epithelial Hyperplasia (Heck Disease)

Answer 4

Asymptomatic, benign condition with multiple white/pink papules
with flat top
Labial, buccal mucosa and tongue are common
Papules occur throughout oral mucosa
Caused by Human Papilloma Virus (HPV) 13 and 32
Histologically unique with elongated rete ridges
Treatment can be excision for esthetic reasons or spontaneously
resolve
No malignant potential
Usually occur in children

Question 5

Verrucous Carcinoma

Answer 5

Commonly caused by chewing tobacco, snuff or
dip
Vestibular mucosa is common location
White, wrinkled, adherent plaque. Associated
gingival recession, stained teeth, tooth
sensitivity and halitosis
Variant of squamous cell carcinoma
Local excision is typically successful, but can
metastasis if not caught early