Oral Florid Papillomatosis Differential Diagnoses

Updated: Apr 16, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Diagnostic Considerations

Histopathological differential diagnosis of verrucous hyperplasia, verrucous keratosis, and verrucous carcinoma can be challenging in small or superficial biopsy specimens [45, 46] and even incisional biopsy specimens. [47]

Verrucous hyperplasia of the oral mucosa and verruca vulgaris should also be considered.

Proliferative verrucous leukoplakia is a rare oral mucosa disorder that may progress to oral squamous cell carcinoma. [48, 49] It can be viewed as an aggressive form of oral leukoplakia with a high rate of recurrence and malignant potential. [50] It affects mainly adult/elderly women and does not correlate with the major risk factors for oral carcinoma. [51]  An expert consensus guideline has recommended the use of standardized histopathologic criteria and descriptive terminology to indicate the following three categories of lesions within proliferative verrucous leukoplakia [52] :

  • “Corrugated ortho(para)hyperkeratotic lesion, not reactive"
  • ”Bulky hyperkeratotic epithelial proliferation, not reactive"
  • ”Suspicious for," or "squamous cell carcinoma"

Classification of proliferative verrucous leukoplakia lesions based on a combination of clinical findings and these histologic descriptive categories is encouraged in order to standardize reporting, aid in future research, and potentially guide clinical management.

Differential Diagnoses