Papillomatosis floride oral C06.9

Kren, 1934; Ackerman, 1948; Rock and Fisher, 1960

Papillomatous, centrifugally expanding, whitish proliferations of the oral mucosa with locally invasive growth of atypical epithelial pilferates, but usually without metastasis. Its independence as an entity is questionable; the clinical picture is classified as a variant of carcinoma verrucosum (Ackerman) (=low malignant spinocellular carcinoma).

The pathogenetic influence of human papillomaviruses (HPV) is currently still unclear. In larger collectives, HPV detection was possible in 10-15% of cases

f>m; advanced age (60-80 years: in larger studies the average age was 69 years)

Oral mucosa (palate, cheek and lip mucosa) and larynx.

Initially, flat leukoplakias develop from which broad, beet-like, papillomatous vegetation with a grey-white, deeply indented surface develops. Large spreading tendency and confluence of individual foci are characteristic, up to the formation of cauliflower-like, easily vulnerable bleeding, solid tumour masses.

Severe hyperplastic epithelial proliferation. Deep folds of the epithelium, which consists of well differentiated cornified squamous epithelium with preserved stratification and only a few mitoses. Displacement of the corium, possibly invasive growth. The histological degree of malignancy is assessed differently.

Focal epithelial hyperplasia, spinocellular carcinoma, oral leukoplakia.

• Operative tumour removal with 3-5 mm safety distance by means of microscopically controlled surgery (see also carcinoma, spinocellular). Remaining tumour residues may lead to the long-term danger of invasively growing squamous cell carcinoma!
• Within the scope of operative dermatology, smaller lesions can be removed without problems. Larger foci belong to the field of maxillofacial surgery.

Notice! Non-cutting procedures such as cryosurgery,_{CO2 laser}, electrocautery are not indicated for florid oral papillomatosis in our opinion!

The term "papillomatosis floride orale" is increasingly losing its meaning after floride oral papillomatosis together with carcinoma cuniculatum, papillomatosis cutis carcinoides and condylomata gigantea were combined to form the term "verrucous carcinoma of the skin/mucosa".

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10. Saghravanian N et al (2015) Human Papilloma Virus in Oral Leukoplakia, Verrucous Carcinoma, Squamous Cell Carcinoma, and Normal Mucous Membrane. Oman Med J 30:455-460
11. Schwartz RA (1995) Verrucous carcinoma of the skin and mucosa. J Am Acad Dermatol. 32: 1-21
12. Wenzel K et al (2003) Malignant conversion of florid oral and labial papillomatosis during topical immunotherapy with imiquimod. Med Microbiol Immunol (Berl) 192: 161-164