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Correspondence

Verruca vulgaris of the buccal mucosa:

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

KEY WORDS: Focal epithelial hyperplasia, oral condyloma acuminatum, squamous papilloma
INTRODUCTION
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
For correspondence:
Dr. Mohit Bhatia,
1, Bank Colony,
Opposite Old
Sessions Courts,
complaints of a white lesion in the left buccal Ambala ‑ 134 003,
Haryana, India.
mucosa since for the past 2 years which was
E‑mail: drbhatia1985@
gradually increasing in size, nontender and was gmail.com
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
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stratified squamous epithelium with thin central
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connective tissue. The epithelium showed areas DOI: 10.4103/jcrt.JCRT_47_17
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Cite this article as: Mattoo A, Bhatia M. Verruca vulgaris of the buccal mucosa: A case report. J Can Res Ther 2018;14:454-6.

454 © 2017 Journal of Cancer Research and Therapeutics | Published by Wolters Kluwer - Medknow
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Mattoo and Bhatia: Verrucous vulgaris
Figure 1: Lesion over the buccal mucosa
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.
DISCUSSION
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]
Journal of Cancer Research and Therapeutics - Volume 14 - Issue 2 - January-March 2018
Figure 2: Epithelium showed areas of parakeratosis with identification
of koilocytes
CONCLUSION
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.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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