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A Guide to Clinical Differential Diagnosis of Oral Mucosal Lesions

Michael W. Finkelstein, DDS, MS

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Benign tumors of squamous epithelium that we will consider in this course are firm, non-tender, white to tan, and have a rough, cauliflower, or warty surface. They are fixed to the surface mucosa.

Papilloma, verruca, and condyloma are warts caused by human papillomavirus.



Papilloma (squamous papilloma)* is a benign epithelial enlargement that is presumably caused by human papilloma virus infection. It is firm, non-painful, and pedunculated. It has a rough white cauliflower or warty surface with numerous fingerlike processes. It arises from the surface stratified squamous epithelium, is exophytic, and it does not invade underlying tissue. Excisional biopsy including the base of the lesion is the treatment. Recurrence is unlikely.

Verruca vulgaris* is a benign epithelial enlargement of skin and mucosa caused by human papilloma virus. It is asymptomatic, exophytic, and has a broad base. The surface is white, rough, and warty. Verruca may be solitary or multiple. Verrucae may spread to other body surfaces by autoinoculation. Sometimes they resolve spontaneously. Verrucae on the skin are usually treated by liquid nitrogen, chemical agents, or surgical excision. Oral verrucae are treated by excisional biopsy.

Condyloma acuminatum

Condyloma acuminatum

Condyloma acuminatum* is a warty soft tissue enlargement caused by human papilloma virus. It is a sexually transmitted disease and is most common in the anogenital region. It often has multiple lesions. Condyloma is treated by surgical excision. The patient's sexual partner should also be treated.

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