October 2002

Case submitted by Youn W. Park, MD, and Iftekhar Husain, MD

		CASE: A 32-year-old man wants to have a growth removed from his upper lip. This unsightly, solitary, warty tumor has been increasing in size for more than a year. The patient is a smoker. No other lesions were found in his upper aerodigestive tract.
What is your diagnosis?
		The growth is a squamous papilloma, the most common oral neoplasm. While association of this tumor with human papilloma virus (HPV) has long been known, HPV has not been identified in all lesions. Usually taking the form of a solitary, pedunculated, painless, exophytic, warty tumor, it occurs on the palate, tongue, gingiva, or lips. Since the base of this patient's tumor is situated mostly in the epithelial layer of the lip, minimal induration of the lip is noted. Microscopically, it shows papillary projections formed by hyperplastic epithelium with a varying degree of keratinization. The color of the tumor is usually determined by the amount of keratinization from pink to white. The differential diagnosis of the lesion includes warty hyperkeratoma, papillary squamous carcinoma, and verrucous carcinoma. To prevent recurrence, complete excision is required.

---

Dr. Park is clinical professor of otolaryngology at Northeastern Ohio Universities College of Medicine and attending physician in the section of otolaryngology at Akron General Medical Center in Akron, Ohio. Dr. Husain is attending physician in the department of medicine at Akron General Medical Center.