1. Oral squamous cell papilloma

Oral wart/ verruca vulgaris (autoinoculation from wart)

• Etiology: HPV 2, 6, 11, 57

• Clinical:
  • Benign growth originating from epidermis
  • Cauliflower like, corrugated surface, exophytic growth
  • Keratinized – appear white
  • Recurrence/multiple lesions in immunocompromised

• Histology:
  • Long thin finger like projections extending from stratified squamous epithelium, enclosing a central vascular CT core
  • Hyperkeratinized epithelium, contains superficial vacuolated cells

• Management: Conservative excision

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2. Focal epithelial hyperplasia

• Etiology: HPV 13, 32

• Clinical: Multiple nodular soft tissue masses

• Histology:
  • Acanthosis
  • Parakeratosis
  • Enlarged ballooning cells with abnormal nuclei

• Management:
  • Spontaneous regression is common
  • Surgical removal if persistent

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3. Verrucous carcinoma

Low grade variant of OSCC

• Etiology:
  • Tobacco
  • HPV 16 & 18

• Clinical:
  • Seen in elderly patient
  • Slow growing exophytic growth/ patch
  • Locally destructive but rarely metastasis

• Sites: Buccal mucosa > gingiva > tongue > palate

• Histology:
  • Well differentiated carcinoma
    • Little/no dysplasia
    • Little pleomorphism
    • Few mitotic figures
  • Bullous rete pegs with blunt pushing margins
  • Keratin plugs + parakeratosis

• Management:
  • Surgical excision
  • Excellent prognosis

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