Oral verruciform hyperkeratotic lesions indicating the presence of plantar or palmoplantar keratodermas.

Oral Surg Oral Med Oral Pathol Oral Radiol

Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, MN, USA; Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA; Institute for Molecular Virology, University of Minnesota, Minneapolis, MN, USA; Center for Genome Engineering, University of Minnesota, Minneapolis, MN, USA; Howard Hughes Medical Institute, University of Minnesota, Minneapolis, MN, USA.

Published: October 2022

The study examines oral verruciform hyperkeratotic lesions (OVHLs) that appear in the gingiva and palate, primarily in the context of proliferative verrucous leukoplakia (PVL), while also exploring their association with skin conditions like plantar keratodermas (PK) and palmoplantar keratodermas (PPKs).
Five patients aged 18 to 64, initially diagnosed with PVL due to their oral leukoplakias, were found to have histopathological features linking their oral lesions to PK or PPKs after biopsies were performed.
The researchers concluded that these oral lesions have distinct histopathological characteristics and a slow biological progression, suggesting that they

Objective: Oral verruciform hyperkeratotic lesions (OVHLs) affecting the gingiva and palate are frequent in proliferative verrucous leukoplakia (PVL). Intraoral hyperkeratotic lesions can also be observed in epidermolytic keratodermas, albeit such association has received limited attention in oral and maxillofacial pathology. The authors report on 5 individuals whose plantar (PK) or palmoplantar keratodermas (PPKs) were confirmed after evaluation of gingival leukoplakic biopsies.

Study Design: Two women and 3 men, ages 18 to 64, presented with solitary or diffuse leukoplakias of the attached gingiva and hard palate, clinically interpreted as PVL. All individuals underwent diagnostic gingival and/or palatal biopsies.

Results: Microscopically, the lesions featured verruciform hyperparakeratosis, occasionally conspicuous hypergranulosis and acanthosis. In the spinous cell layer, numerous cells presented with vacuolated cytoplasm and paranuclear eosinophilic condensations that, infrequently, engulfed the nucleus. The histopathologic findings were interpreted as verrucous hyperkeratosis consistent with those described in epidermolytic PPKs. Further evaluation of the individuals for cutaneous lesions disclosed PK or PPKs in all 5 patients. Additionally, the men exhibited elbow and subungual hyperkeratoses. A family history of keratodermas was confirmed in all 3 male individuals.

Conclusions: Gingival and/or palatal OVHLs associated with PK and PPKs display pathognomonic histopathologic features and exhibit indolent biologic behavior. Therefore, any confusion with PVL should be avoided to prevent overtreatment.

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http://dx.doi.org/10.1016/j.oooo.2022.04.044	DOI Listing

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