Wart Variants and Other HPV-Related Lesions

Bowenoid papulosis*

Flat, brown, verrucous papules on the vulva and penis

Buschke-Löwenstein tumor

Large cauliflower-like tumors on the anogenital surface

Butcher’s wart (meat handler’s wart)

Common warts, usually benign, that occur on the hands of meat workers

May appear more cauliflower-like than common warts

Common warts

Sharply demarcated, rough, round or irregular, firm, and light gray, yellow, brown, or gray-black nodules 2 to 10 mm in diameter

Epidermodysplasia verruciformis

Flat-topped white, brown, or red papules or larger more raised papules resembling a seborrheic keratosis

Rare, inherited predisposition to developing widespread HPV infection and often skin cancer (such as squamous cell carcinoma) as early as a patient's 20s

External genital warts

Discrete flat to broad-based smooth to velvety papules to rough and pedunculated excrescences on the perineal, perirectal, labial, and penile areas

Flat warts (plane warts)

Smooth, flat-topped, yellow-brown, pink, or skin-colored papules

Keratoacanthoma

Thought to be a well-differentiated squamous cell carcinoma

Laryngeal papillomas

One or more wart-like lesions on the larynx or elsewhere in the respiratory tract

Called recurrent respiratory papillomatosis in children

Oral focal epithelial hyperplasia (Heck disease)

Multiple pale, flat-topped, cobblestoned papules in the lining of the mouth

Oral papillomas

Common, painless lesions anywhere in the mouth

Oropharyngeal carcinoma

Can involve the tongue, tonsils, soft palate, or the walls of the pharynx

Palmar and plantar warts

Are often tender and plantar warts can make walking and standing uncomfortable

Periungual warts

Thickened, fissured, cauliflower-like skin around the nail plate, usually asymptomatic, but can be painful as they enlarge

Warts in kidney transplant patients

Often multiple and difficult to treat

HPV-associated mucosal and anogenital cancers

Various manifestations, see anal cancer, cervical cancer, penile cancer, vaginal cancer, vulvar cancer