Florid Cutaneous Papillomatosis Workup

Updated: Apr 16, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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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 [31] 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. [32, 33]