Heck's Disease in Saudi Patients: A Case Series and Literature Review

Heck's disease, also known as focal epithelial hyperplasia, is a rare benign oral mucosal condition primarily associated with human papillomavirus (HPV) infection. It typically presents as single or multiple, soft, well-delimited sessile papules or nodules that share the same color as the surrounding mucosa. The condition is more frequently observed in females and predominantly affects children. Although it was initially identified among Native American, Inuit, and African populations, Heck's disease is now recognized worldwide. Some studies have suggested a possible genetic predisposition linked to the human leukocyte antigen (HLA)-DR locus. This report describes three cases of Heck's disease. The first case is a 70-year-old female patient who presented with four whitish, smooth, round lesions located on the upper and lower labial mucosa and the left lateral surface of the tongue. The second case concerns a 39-year-old female patient who exhibited a single white, slightly raised, dome-shaped nodule with a smooth surface on the right side of her tongue. The third case describes a 49-year-old female patient who presented with a pinkish-white lesion measuring approximately 0.3 mm on the left lateral border of the tongue. All three cases were confirmed histopathologically as Heck's disease following excisional biopsy. Notably, two of the patients were sisters, suggesting the potential role of familial or genetic factors in the disease's pathogenesis. In conclusion, this case series contributes to the limited literature on Heck's disease and underscores the need for further research into its genetic associations, particularly among the Saudi population. Comparing the clinical and genetic characteristics of these cases with previously documented cases worldwide may provide valuable insight into the disease's etiology and distribution patterns.