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Year : 2018  |  Volume : 14  |  Issue : 2  |  Page : 454-456

Verruca vulgaris of the buccal mucosa: A case report

Department of ENT, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India

Date of Web Publication8-Mar-2018

Correspondence Address:
Mohit Bhatia
1, Bank Colony, Opposite Old Sessions Courts, Ambala - 134 003, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrt.JCRT_47_17

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 > Abstract 

Oral verruca vulgaris is caused by human papillomavirus (HPV) infection. Verruca vulgaris most frequently occurs on the fingers, toes, soles, and dorsal surfaces of hands and is mostly asymptomatic. Varieties of verrucous and papillary lesions affect the skin as well as oral mucosa which may be either benign or reactive. Common wart is one of the most commonly observed skin growths and a lesion of childhood. Intraoral warts can occur at any age with equal incidence in both genders but are most commonly seen in the third to fifth decade. It is found commonly on the palate followed by lip, tongue, buccal mucosa, and rarely seen on gingiva. Surgical excision with adequate margins is the treatment of choice.

Keywords: Focal epithelial hyperplasia, oral condyloma acuminatum, squamous papilloma

How to cite this article:
Mattoo A, Bhatia M. Verruca vulgaris of the buccal mucosa: A case report. J Can Res Ther 2018;14:454-6

How to cite this URL:
Mattoo A, Bhatia M. Verruca vulgaris of the buccal mucosa: A case report. J Can Res Ther [serial online] 2018 [cited 2022 Jul 4];14:454-6. Available from: https://www.cancerjournal.net/text.asp?2018/14/2/454/208755

 > Introduction Top

Oral verruca vulgaris is a benign proliferation of the stratified squamous epithelium, which results in a papillary or verrucous exophytic mass. Commonly being associated with human papillomavirus (HPV) 6 and 11.[1]

Oral HPV lesions can result in different clinical appearance, ranging from benign, hyperplastic, papillomatous, or verrucous lesions to carcinomatous changes.[2] The sites of predilection for localization of verruca vulgaris include the tongue and soft palate, but any surface of the oral cavity can be affected. Nonkeratinized lesions appear coral pink; if keratinized, they are white. Some have a cauliflower surface whereas others have discrete finger-like projections. It is an innocuous lesion that is neither transmissible nor threatening.[3] In recent decades, due to the increased practice of oral sex, papilloma has been associated with squamous cell carcinoma of the head and neck, particularly oropharyngeal carcinoma.[4] Hence, correct diagnosis and early detection and treatment are required. Here, we present a case of oral verruca vulgaris lesion of the buccal mucosa along with review of literature.

 > Case Report Top

A 48-year-old married male presented to the Department of Otorhinolaryngology with chief complaints of a white lesion in the left buccal mucosa since for the past 2 years which was gradually increasing in size, nontender and was not associated with any symptoms.

On examination, a solitary proliferative verrucous growth over the left buccal mucosa was seen. The lesion was exophytic and sessile in nature, approximately 2 cm × 3 cm in size, with irregular margins. Surface of the lesion was irregular at the periphery with finger-like projections in the center. The color was white and soft in consistency [Figure 1]. The surrounding mucosa appeared normal. There was no any other such lesion in oral cavity nor extraorally. No cervical lymph nodes were palpable. The patient had a history of smoking and betel nut chewing for the past 10–12 years. A provisional diagnosis of verruca vulgaris was made. Under local anesthesia, the lesion was completely excised and sent for histopathological examination. The patient was advised to get an HPV DNA by polymerase chain reaction which was found to be positive. Histopathological examination showed long, thin, and finger-like projections lined by stratified squamous epithelium with thin central connective tissue. The epithelium showed areas of parakeratosis with identification of koilocytes, with perinuclear cytoplasmic halos, and irregular hyperchromatic nuclei [Figure 2]. The clinical follow-up showed complete tissue healing, and no recurrence had been seen at the 1-year follow-up.
Figure 1: Lesion over the buccal mucosa

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Figure 2: Epithelium showed areas of parakeratosis with identification of koilocytes

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 > Discussion Top

HPVs are a group of DNA viruses, HPVs are members of the Papovaviridae family, which are small icosahedral viruses that contain circular DNA.[5] The HPVs which have a remarkable target cell specificity: they have been reported principally in anogenital tract, urethra, skin, larynx, tracheobronchial mucosa, and oral cavity.[6]

More than 100 different types of HPV have been classified and they are divided into high and low oncogenic risk genotypes, depending on the association with malignant change. The viral products stimulate cell growth in the basal layer leading to formation of a common wart. Since the recognition of high-risk HPVs in oral carcinomas, the malignant potential of HPV infection has been suggested.[7] Potential vaccines have been developed which helps in preventing HPV 16 and 18 infections. These vaccines reduce the risk of developing cancerous or precancerous changes.[8] Entities such as oral lichen planus, lupus vulgaris, and squamous cell carcinoma should be considered as the differential diagnosis.

Its histopathological picture reveals finger-like projections of hyperkeratotic stratified squamous epithelium producing a cupping effect and showing characteristically seen koilocytes.[9]

Various treatment modalities are considered ranging from topical agents such as salicylic acid which might lead to tissue damage.[10] Cryotherapy, laser surgery are considered pain free and effective treatment options. Vitamin derivatives in the form of retinoids inhibit cell growth and are considered an effective treatment option. However, surgical excision remains widely practiced and effective cure for these lesions.[11],[12]

 > Conclusion Top

Verrucous lesions remain a challenge to diagnose and treat at an early stage. However, with clinical acumen and various modalities available, the diagnosis at an early stage provides a boon in management of such lesions which have the propensity to turn into malignant lesions. The diagnosis of HPV-associated oral lesions is essentially clinical, but histological confirmation is normally recommended.

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Conflicts of interest

There are no conflicts of interest.

 > References Top

Major T, Szarka K, Sziklai I, Gergely L, Czeglédy J. The characteristics of human papillomavirus DNA in head and neck cancers and papillomas. J Clin Pathol 2005;58:51-5.  Back to cited text no. 1
Maitland NJ, Cox MF, Lynas C, Prime SS, Meanwell CA, Scully C. Detection of human papillomavirus DNA in biopsies of human oral tissue. Br J Cancer 1987;56:245-50.  Back to cited text no. 2
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and maxillofacial pathology. 2nd ed. Philadelphia: W.B. Saunders; 2002. p. 621-3.  Back to cited text no. 3
D'Souza G, Kreimer AR, Viscidi R, Pawlita M, Fakhry C, Koch WM, et al. Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 2007;356:1944-56.  Back to cited text no. 4
de Villiers EM, Fauquet C, Broker TR, Bernard HU, zur Hausen H. Classification of papillomaviruses. Virology 2004;324:17-27.  Back to cited text no. 5
Reid R, Campion MJ. The biology and significance of human papillomavirus infections in the genital tract. Yale J Biol Med 1988;61:307-25.  Back to cited text no. 6
Praetorius F. HPV-associated diseases of oral mucosa. Clin Dermatol 1997;15:399-413.  Back to cited text no. 7
Denny LA, Franceschi S, de Sanjosé S, Heard I, Moscicki AB, Palefsky J. Human papillomavirus, human immunodeficiency virus and immunosuppression. Vaccine 2012;30 Suppl 5:F168-74.  Back to cited text no. 8
Koss LG, Durfee GR. Unusual patterns of squamous epithelium of the uterine cervix: Cytologic and pathologic study of koilocytotic atypia. Ann N Y Acad Sci 1956;63:1245-61.  Back to cited text no. 9
Nucci V, Torchia D, Cappugi P. Condyloma acuminatum of the tongue treated with photodynamic therapy. Clin Infect Dis 2009;48:1330-2.  Back to cited text no. 10
Lipke MM. An armamentarium of wart treatments. Clin Med Res 2006;4:273-93.  Back to cited text no. 11
Parsad D, Pandhi R, Juneja A, Negi KS. Cimetidine and levamisole versus cimetidine alone for recalcitrant warts in children. Pediatr Dermatol 2001;18:349-52.  Back to cited text no. 12


  [Figure 1], [Figure 2]


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