HPV-positive oral papillomas in an adolescent—A diagnostic d
Human papillomavirus oral papilloma is often sexually transmitted, but non-sexual modes of transmission should be considered, including autoinoculation from skin lesions. A patient-centered multimodality approach should be utilized in the pediatric population.

A healthy 13-year-old female presented to Penn State Otolaryngology—Head and Neck outpatient clinic with a 9-month history of intraoral papillomas first noticed at the dentist. She denied pain, dysphagia, or contact bleeding. Past medical history was only significant for multiple palmar verrucae 2 years prior that were treated by dermatology with Candida antigen injections, squaric acid 2%, and cryotherapy. She also endorsed a history of frequent nail-biting, and based on our records, had not received the HPV vaccination series prior to presentation.

On physical examination, there were multiple clusters of papillomas on the bilateral buccal mucosa with one large isolated papilloma on the right buccal mucosa measuring approximately 2 cm × 3 cm. There were also multiple papillomas in the intraoral mucosa of the lower lip and the right and left commissures. Biopsies of the lesions were positive for HPV types 6 and 11, and negative for types 16, 18, 31, and 33.

The concern for possible sexual abuse was raised due to the HPV positivity; however, the patient adamantly denied any previous sexual activity and further investigation by child services did not identify evidence of sexual abuse. Given the diffuse nature of the lesions, the patient wished to proceed with operative intervention. The large right buccal papilloma was excised and repaired primarily due to its size. To minimize scarring along the lower lip, CO2 laser ablation of the smaller papillomas was performed.

The etiology of HPV-positive oral squamous papillomas in sexually naive patients remains unclear. While it can be hypothesized that this patient's lesions may have been a result of autoinoculation by HPV-positive skin lesions, this has not been proven and the exact etiology remains unknown. Further investigation into alternate non-sexual modes of transmission is warranted to elucidate this diagnostic dilemma.

Source: https://onlinelibrary.wiley.com/doi/10.1002/ccr3.4546?af=R
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