Public Health · Vol. 11, No. 1 · 2026 · pp. 99–103 · e-ISSN 2472-3878

Excision of Oral Verrucous Hyperplasia With Long Term Follow Up: A Case Report

Nakka Abhishek, Aathira Velu, Vikas Kumar Kirar, Meghna Mehta, Bhakti Rajput

DOI: https://doi.org/10.17140/phoj.11.01.99 · Published 2026-02-20 · Licence: https://creativecommons.org/licenses/by/4.0 · © 2026 The Author(s)

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Abstract

Oral verrucous hyperplasia (OVH) is a benign but a potentially premalignant exophytic epithelial lesion, often it is considered as a precursor to verrucous carcinoma. Clinically, it presents as a white, warty, or cauliflower-like growth, commonly seen on the buccal mucosa, gingiva, or alveolar ridge. It is frequently associated with chronic tobacco or betel quid use. Accurate diagnosis and complete excision are crucial. Both clinically and histologically Oral verrucous hyperplasia may mimic verrucous carcinoma

Introduction

Oralverrucoushyperplasia(OVH)isadistinctexophytic epithelialproliferationthatwasfirstdescribedbyShear andPindborgin1980asapotentiallymalignantdisorderoftheoralmucosa.Itisregardedastheprecursor orearlycounterpartofverrucouscarcinoma(VC)and representsahistopathologicalcontinuumbetweenbenignhyperplasiaandcarcinoma[1,2].Clinically,OVH presentsasawhite,warty,orcauliflower-likegrowth thatcanoccuronanyoralmucosalsurface,butthebuccalmucosa,alveolarridge,andgingivaarethemost frequentlyaffectedsites. Itcommonlyarisesinindividualswithchronicexposuretocarcinogenicagents suchastobacco,betelquid,andarecanut,andisoftenassociatedwithpoororalhygieneandchronicirritation[3,4]. TheOVHhasanetiopathogenesisthat ismultifactorial.Long-termtobaccouseremainsthe mostestablishedriskfactor,whileotherpotentialcontributorssuchasalcohol,humanpapillomavirus(HPV) infection, and genetic susceptibility have also been implicated[5]. Thelesionismoreprevalentamong malesinthefifthtoseventhdecadesoflifeandisoften asymptomaticinitsearlystages,leadingtodelayed clinicalpresentationanddiagnosis.ThemajordiagnosticchallengeliesindifferentiatingOVHfromverrucous carcinoma and other verruca-papillary lesions such asproliferativeverrucousleukoplakia,papillarysquamouscellcarcinoma,andchronichyperplasticcandidiasis[6].Histopathologically,OVHischaracterizedbya thickenedstratifiedsquamousepitheliumwithhyperparakeratosisandacanthosis,showingbroad,blunt reteridgesthatprojectoutwardratherthandownward. Thekeydifferentiatingfeaturefromverrucouscarcinomaistheabsenceofepithelialinvasionbeyondthe basementmembraneorintotheunderlyingconnectivetissue[7]. Despitebeingnon-invasive,OVHisregardedasapremalignantlesionwiththepotentialto transformintoverrucouscarcinomaorconventional squamouscellcarcinomaifnottreatedpromptly[8]. Severalmanagementoptionshavebeenproposed,includingconventionalsurgicalexcision,laserablation, cryosurgery,andphotodynamictherapy.Amongthese, widelocalexcisionwithadequatemarginsremainsthe mostacceptedandeffectivetreatmentmodality.Surgicalexcisionnotonlyensurescompleteremovalofthe lesionbutalsoprovidestissuefordefinitivehistopathologicalevaluation,whichisessentialforrulingoutearly malignanttransformation[9].Conservativebutcompleteexcisionfollowedbyregularfollow-upisthereforetherecommendedapproachforoptimalpatient outcomes. Thepresentarticlereportsacaseoforal verrucoushyperplasiamanagedsurgically,withemphasisonclinicalpresentation,histopathologicalfealation.Thecasehighlightstheroleofsurgicalexcision inensuringdiseasecontrolandpreventingmalignant transformation.

Casepresentation

A60yearoldfemalereportedwithaswellinginthe leftlowerbackregion.Onintraoralexaminationthe swellingwasseenontheleftbuccalmucosafoundto bepainless,warty,pinkishlesion.(Fig.1)Thegrossfindingsofthelesionshowedexophyticgrowthmeasuring 2x1.4x1 cm. The exophytic growth for examinationmeasured1x1x1.5cm.Thegrey-whitesectionof growthonhistopathologicalexaminationofexcisional biopsyofleftbuccalmucosathefeaturesweresuggestiveofVerrucousHyperplasia.

Figure 1
Figure 1. Pre-op Microscopicexaminationshowedhyperplasticstrati- fiedsquamousepitheliumarrangedintheformofexo- phyticpapillaryprojectionswithunderlyingfibrovascu- larandmusculartissue.Superficialepitheliumshowed fewkoilocytes.Broadreteridgesareseenwhilesome

ofthecellsofbasallayersexhibitsdysplasticfeatures. Underlyingconnectivetissueshowschronicinflammatorycellinfiltrate.Noevidenceofmalignancywasseen inthesectionexamined.(Fig.2) Thelesionandaclinicalmarginof3–5mmofadjacent normalmucosawasoutlinedtoensurecompleteexcision. ANo. 15scalpelbladewasusedtomakean incisionalongthemarkedoutline. (Fig. 3)Theincisionwasplacedatanangle(approximately45°)tothe mucosalsurfacetoachieveathree-dimensionalexcisionandtomaximisedepthcentrally.Sharpdissection wasperformed,separatingthelesionfromunderlying

Figure 2
Figure 2. HistopathologyReport submucosaandperiosteumwhereapplicable.(Fig.4) Thesurgeonensuresremovalofallclinicallyinvolved tissueandanadequatedepthismaintainedtoachieve clearhistologicalmargins.Haemostasisisachievedus- ingpressurepack,electrocautery,orchemicalagents

asneeded.TheexcisedspecimenisorientedandsubmittedforhistopathologicalevaluationtoconfirmOVH andassessmarginstatus.Thesurgicaldefectismanageddependingonsize.(Fig.5 6)Smallmucosaldefectscanbeclosedprimarily. Largerdefectsmayrequirereconstructiveoptionssuchasbuccalfatpadadvancementorlocalsoft-tissueflapstoensureoptimal healingandfunctionaloutcomes.Aperiodontalpack (e.g.,Coe-Pak)maybeplacedtoprotectthesurgical site.

Figure 3
Figure 3. Incisionbeingmadetoresectthemass
Figure 4
Figure 4. Siteafterremovalofthemass PostoperativeCareincludedprescriptionofanalgesics andantibiotics.Chlorhexidinemouthrinsewasrecom- mendedtomaintainoralhygiene.Patientwasadvised tostayonasoftdietandavoidanceoftraumatothesur- gicalsite.Regularpostoperativefollow-upisnecessary

tomonitorhealing,detectrecurrenceearly,andmanageanydysplasticormalignanttransformation.Initial follow-upat1weekassesseswoundhealing,withperiodicreviewsat1,3,6,and12monthsthereafter.

Figure 5
Figure 5. Siteaftersutureplacement
Figure 6
Figure 6. Excisedmass

Discussion

Oralverrucoushyperplasia(OVH)isadistinctexophytic epitheliallesionclassifiedunderoralpotentiallymalignantdisorders.Itisregardedasanearlystageinthe biologicalcontinuumthatmayprogresstoverrucous carcinomaorconventionalsquamouscellcarcinoma. [1,2]Earlyrecognitionandpromptmanagementare essential to prevent malignant transformation. [8] Thepresentcasehighlightstheclassicalclinicaland histopathologicalfeaturesofOVHandemphasizesthe role of surgical excision and long-term surveillance. Clinically,OVHpresentsasaslow-growing,painless, verrucopapillarylesionwithacharacteristicwartyor cauliflower-likesurface.Thebuccalmucosa,gingiva, and alveolar ridge are the most commonly affected sites.[3,4]Inthepresentcase,thelesioninvolvedthe leftbuccalmucosa,whichcorrelateswithpreviously reportedsitepredilection.[4]AlthoughOVHpredominantlyaffectsmalesinthefifthtoseventhdecades oflife,theoccurrenceinafemalepatientinthesixth decade underscores the importance of clinical vigilanceirrespectiveofgender.[2,3]Theasymptomatic nature and indolent progression of the lesion often contributetodelayeddiagnosis.Histopathologicalexaminationiscrucialfordefinitivediagnosisanddifferentiationfromverrucouscarcinoma.OVHischaracterizedbyhyperplasticstratifiedsquamousepithelium formingexophyticpapillaryprojections,surfacehyperkeratosis,broadandbluntreteridges,andabsenceof epithelialinvasionintotheunderlyingconnectivetissue.[1,7]Inthepresentcase,theseclassicalfeatures wereobservedalongwithfocalkoilocytosisandmild dysplasia,supportingthediagnosisofOVH.[5]Differentiationfromverrucouscarcinomaisessential,asthe latterexhibitspushingmarginswithdownwardproliferationbeyondthebasementmembrane,necessitating moreaggressivemanagement.[7]TheetiopathogenesisofOVHismultifactorial,withtobaccouseandbetel quidchewingbeingthemostsignificantcontributing factors.[2,3,4]Chronicmucosalirritationleadstoepithelialhyperplasiaanddysplasticchanges,thereby increasingmalignantpotential.[8]Additionalfactors suchasalcoholconsumption, viralinfections, nutritionaldeficiencies,chronictrauma,andgeneticpredispositionhavealsobeenimplicated.[5,8]Elimination ofetiologicalhabitsandpatientcounselingformanintegralpartofcomprehensivemanagement.Widelocal surgicalexcisionremainsthetreatmentofchoicefor OVH.[6]Completeremovalwithadequatemarginsensureseliminationofdysplastictissueandfacilitates thorough histopathological evaluation. [6,9] In the presentcase,excisionwitha3–5mmclinicalmargin resultedinsatisfactoryhealingandabsenceofrecurrenceduringfollow-up.Alternativetherapeuticmodalitiessuchaslaserablation, cryosurgery, andphotodynamictherapyhavebeenadvocated;however,conventionalscalpelexcisionremainsthegoldstandard duetopredictablehealing,cost-effectiveness,andreliablehistologicalassessment.[6,9]Long-termfollowupismandatoryowingtothedocumentedriskofrecurrenceandmalignanttransformation.[8]Regularclinicalsurveillanceenablesearlydetectionofrecurrentor progressivelesions,therebyimprovingprognosis.This casereinforcestheimportanceofanintegratedclinicopathologicalapproach,timelysurgicalintervention, andstructuredfollow-upprotocolforoptimalpatient outcomes.

Summary

Oralverrucoushyperplasiaisapotentiallymalignant exophyticlesionrequiringearlydiagnosisandintervention. This case describes a 60-year-old female withapainlessverruca-papillarylesionoftheleftbuccal mucosa managed by complete surgical excision. Histopathologicalconfirmationandregularfollow-up ensuredoptimalhealing,absenceofrecurrence,and preventionofmalignanttransformation.

References

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