Human papillomavirus infection of the oral mucosa

This article reviews the lesions of oral mucosa that contain human papillomavirus (HPV). These HPV-associated lesions can be classified into two broad types on the basis of their biologic behavior, benign lesions and premalignant malignant or malignant lesions. Benign oral lesions include squamous cell papilloma (SCP), verruca vulgaris (VV), condyloma acuminatum (CA), and focal epithelial hyperplasia (FEH). Of these entities, VV, CA, and FEH demonstrate characteristic HPV-induced cytopathic effects, whereas SCP infrequently shows such changes. All of these lesions show a clear association with HPV. Premalignant and malignant oral lesions include leukoplakia and squamous cell carcinoma. The etiologic role of HPV in these lesions is still unclear. Koilocytosis is the most common cytopathic effect seen in both groups of lesions. Even though it is sometimes difficult to distinguish between hyperplastic lesions such as SCP, VV, and CA, clinical and certain histologic features can facilitate the diagnosis. Although exceptions do exist, each of the two classes of lesions is most commonly associated with particular HPV types. The benign oral lesions are associated with HPV 2, 4, 6, 11, 13, and 32; the malignant oral lesions are associated with HPV 16 and 18. No preferential association has been demonstrated between specific HPV types and a particular oral lesion.