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Florid Cutaneous Papillomatosis Workup

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
Updated: Jun 24, 2016

Histologic Findings

The cutaneous papillomas are uniform with pronounced hyperkeratosis, acanthosis, and papillomatosis. They lack evidence of epidermal vacuolization, parakeratosis, or eosinophilic inclusions suggestive of viral warts; however, patients in one study[26] did have these findings.

Results of ultrastructural evaluation, immunofluorescence tests, viral serologic tests, and DNA hybridization analyses to detect human papillomavirus in skin papillomas have been negative.[1] Accordingly, a viral origin is unlikely.

The principle concern in the differential diagnosis of florid cutaneous papillomatosis is viral warts. Florid cutaneous papillomatosis may morphologically resemble viral warts, but the microscopic changes in the granular layer of florid cutaneous papillomatosis are not present as they are in verruca vulgaris. The verrucous velvety pattern of malignant acanthosis nigricans facilitates the distinction, although acanthosis nigricans and florid cutaneous papillomatosis often occur together.

The sudden eruption of multiple seborrheic keratoses or the sign of Leser-Trélat may occur with acanthosis nigricans and florid cutaneous papillomatosis. Each seborrheic keratosis is a discrete verrucous nodule that appears as if it has been stuck on the skin. This nodule is easily distinguished from viral warts after careful scrutiny. However, patients have been reported to have oral acanthosis nigricans with multiple verrucouslike nodules on all of the extremities or rice- to pea-sized nodules on the trunk; these findings do not allow the reader to distinguish between the sign of Leser-Trélat and florid cutaneous papillomatosis.[27, 28]

Contributor Information and Disclosures

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Takeji Nishikawa, MD Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc

Disclosure: Nothing to disclose.


The assistance of Edmund Janniger is greatly appreciated.

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