Benign Epithelial Pathology

HPV

• Double stranded DNA virus

• Tropism for squamous epithelium (likes to infect skin and mucosa)

• Most individuals are asymptomatic

• Transmission through sexual and nonsexual person-to-person

contact, salivary transfer, contaminated objects, autoinoculation,

breast-feeding, perinatal transmission, and, possibly, prenatal

transmission

yes

is squamous papilloma associated with HPV

squamous papilloma

Which benign epithelial lesion:

• Benign papillary or verruciform

lesion

• HPV types: 6 and 11 (low-risk)

• Very common

• Tongue, lip, soft palate

• Can occur at any age

• Asymptomatic

• 0.5 cm to 3.0 cm

• Soft, painless, exophytic nodule

• Finger-like projections

• Cauliflower or wart-like

• May be pink or white

squamous papilloma

histology of which benign epithelial lesion:

• Finger-like projections

• Fibrovascular cores

• Koilocytes (virally-altered

epithelial cells)

squamous papilloma

squamous papilloma

treatment for which benign epithelial lesion:

• Conservative surgical excision

• No malignant transformation

yes

is verruca vulgaris associated with HPV

verruca vulgaris

Which benign epithelial lesion:

• HPV Type: 2 (low-risk)

• Occur on the skin much more

commonly than the oral mucosa

• Most common in kids

• May be multiple

• Painless papule or nodule

• Papillary projections

• Rough, pebbly surface

• Usually white when in the oral

cavity

verruca vulgaris

histology of which benign epithelial lesion:

• Very, very similar to squamous

papilloma

• Hyperkeratotic

• Finger-like, pointed projections

• Cupping effect

• Koilocytes

verruca vulgaris

treatment for which benign epithelial lesion:

• Surgical excision

• 2/3 disappear spontaneously

with no treatment

• No malignant transformation

verruca vulgaris

verruca vulgaris histology

yes

are condyloma acuminatum associated with HPV

condyloma acuminatum

Which benign epithelial lesion:

• Can involve any mucosal

surfaces

• Usually attributed to HPV 6, 11

(low-risk)

• Autoinoculation is possible

• Sessile

• Pink

• Non-tender

• Exophytic mass

• Short, blunted projections

• Multiple/clustered

condyloma acuminatum

treatment for which benign epithelial lesion:

• Conservative surgical excision

• Vaccine for prevention

condyloma acuminatum

yes

is multifocal epithelial hyperplasia associated with HPV

Multifocal Epithelial Hyperplasia

Which benign epithelial lesion:

• HPV types 13 and 32 (low-risk)

• Usually affects children and

household transmission is

common

• Multiple

• Small (0.1-1.0cm)

• Pink

• Well-demarcated

• Flat-topped or round

papules/nodules

• "Cobblestone"

• Pebbly

Risk factors:

• Genetic susceptibility

• Lower socioeconomic status

• Crowded living conditions

• Poor hygiene

• Malnutrition

• HIV infection/immunodeficiencyMultifocal Epithelial Hyperplasia

Multifocal Epithelial Hyperplasia

treatment for which benign epithelial lesion:

• Spontaneous regression

• Recurrence is possible

• No malignant potential

• Excision for diagnosis or

esthetics

Multifocal Epithelial Hyperplasia

no

is molluscum contagiosum associated with HPV

molluscum contagiosum

Which benign epithelial lesion:

• Molluscum contagiosum virus

• Children and young adults

• Skin of the neck, face, trunk,

genitalia

• Oral involvement is rare

• Contagious

• Most are asymptomatic

• Multiple, clustered, white or

pink, smooth-surfaced sessile

papules (2-4mm)

• Central indentation/plug

• Umbilication

molluscum contagiosum

treatment for which benign epithelial lesion:

• Spontaneous remission in 6-9

months

• Recurrence in ⅓

• Curettage or cryotherapy

molluscum contagiosum

Verruciform xanthoma

Which benign epithelial lesion:

• Accumulation of lipid-laden

histiocytes called xanthoma cells

• Not associated with viruses, or

metabolic conditions

• Cause is unknown but likely a

reaction to trauma

• Asymptomatic

• Well-demarcated

• Sessile

• Slightly elevated mass

• Yellow, white, or red

• Papillary/roughened (verruciform) surface

• 50% on the gingiva or alveolar

mucosa

• Can mimic squamous cell

carcinoma

Verruciform xanthoma

treatment for which benign epithelial lesion:

• Excision is the treatment of choice

• Tend not to recur even if incompletely excised

Verruciform xanthoma

Verruciform xanthoma histology

no

is sebaceous hyperplasia associated with HPV

sebaceous hyperplasia

Which benign epithelial lesion:

• Non-tender papules

• Yellow, white or skin-colored

• Slow growing

• Central umbilication

sebaceous hyperplasia

treatment for which benign epithelial lesion:

• No treatment is necessary

• Except for cosmetic reasons or if basal cell carcinoma cannot be eliminated

from the clinical differential diagnosis

sebaceous hyperplasia

sebaceous hyperplasia histology

seborrheic keratosis

which type of pigmented lesion:

• Extremely common lesion in

older patients

• Unknown cause

• Does not occur in the mouth

• Brown-tan macules that over

time become sharply

demarcated plaques

• Can be rough, fissured,

verrucous

• "Stuck on" appearance

seborrheic keratosis

treatment for which type of pigmented lesion:

• Rarely removed unless there are

esthetic concerns or they are

becoming irritated

• No malignant potential

seborrheic keratosis

ephelis

which type of pigmented lesion:

• Focal area of increased melanin

• NOT an increase in number of

melanocytes

• More pronounced after sun

exposure

• Common

• Become less prominent over

time

• Does not occur in the mouth

• <0.3 cm

• Sharply demarcated

• Round/oval

• Uniformly light brown macule

ephelis

treatment for which type of pigmented lesion:

• No treatment is necessary

ephelis

actinic lentigo

which type of pigmented lesion:

• Benign

• Found on photo damaged skin

• 90% of elderly Caucasians

• Does not occur in the mouth

• <0.5cm

• Uniformly pigmented

• Brown to tan macules

• Well-demarcated but irregular

borders

• Lesions may coalesce

actinic lentigo

treatment for which type of pigmented lesion:

• No treatment except for

cosmetic reasons

• Sunscreen = Prevention

• Does NOT undergo malignant

transformation

• Photo damaged skin indicates a

risk for developing other skin

cancers

actinic lentigo

oral melanotic macule

which type of pigmented lesion:

• Solitary mucosal discoloration

• Increase in melanin deposition

and increase in melanocytes

• Cause is unknown

• Not dependent on sun exposure

• Most common oral melanocytic

lesions submitted to oral

pathology laboratories

• Discrete, usually solitary, tan-to-

brown-to-black, painless

macules

• Evenly pigmented

• Less than 1 cm

oral melanotic macule

treatment for which type of pigmented lesion:

• No treatment is necessary, but I

recommend biopsy of all oral

pigmented lesions

• Has no malignant potential, but

it is necessary to rule out the

possibility that it could be

melanoma

oral melanotic macule

oral melanoacanthoma

which type of pigmented lesion:

• Benign

• Acquired pigmentation

• Reactive

• Female predilection

• More common in those of

African descent

• Lesions rapidly increase in size

• Flat, brown to black

• Irregular borders

oral melanoacanthoma

treatment for which type of pigmented lesion:

• Biopsy to rule out melanoma

• Once diagnosis is established, no

treatment is necessary

• Lesions fade over time

• No malignant potential

oral melanoacanthoma

Acquired melanocytic nevus

which type of pigmented lesion:

• Common mole

• Benign proliferation of nevus

cells

• "Most common of all human

tumors"

extraoral:

• Asymptomatic

• Round

• Slightly raised

• Brown to black

• Uniformly pigmented

intraoral:

• Uncommon

• More than one in five intraoral

nevi lack pigmentation

Acquired melanocytic nevus

treatment for which type of pigmented lesion:

• It's a pigmented lesion so you

know I want you to biopsy it

• Once the diagnosis is

established, no treatment is

necessary

• Recurrence is unlikely

• Current evidence does not

suggest that oral melanocytic

nevi are a marker of increased

risk for developing oral mucosal

melanoma

Acquired melanocytic nevus

blue nevus

which type of pigmented lesion:

• Uncommon

• Benign proliferation of

melanocytes deep in the

connective tissue

• Children/YA

• Blue in color→ Tyndall Effect

• Usually found on the palate

blue nevus

treatment for which type of pigmented lesion:

• It's pigmented so I want you to

biopsy it

• Conservative excision is curative

• Transformation to melanoma

has been reported

blue nevus