Wart Variants and Other HPV-Related Lesions

Clinical Form

Human Papillomavirus Type

Description

Bowenoid papulosis*

16, 55

Flat, brown, verrucous papules on the vulva and penis

Buschke-Löwenstein tumor

6

Large cauliflower-like tumors on the anogenital surface

Butcher’s wart (meat handler’s wart)

7

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

May appear more cauliflower-like than common warts

Common warts

1, 2, 4, 7, 75–77

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

Epidermodysplasia verruciformis

3, 5, 8, 9, 10, 12, 14, 15, 17, 19, 20, 21–25, 36–39, 47, 49

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

6 and 11 (most commonly), and 1a, 2, 4, 7, 16, 18, 27b, 27, 33, 38, 40, 42, 43, 44, 54, 57b, 57c, 61, 65, 72, 81, 89†

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)

3, 10, 26–29, 41

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

Keratoacanthoma

77

Thought to be a well-differentiated squamous cell carcinoma

Laryngeal papillomas

6, 11

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)

13, 32

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

Oral papillomas

2, 6, 7, 11, 16, 18, 32, 57

Common, painless lesion anywhere in the mouth

Oropharyngeal carcinoma

16 (predominantly), 18

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

Palmar and plantar warts

1, 2, 4

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

Periungual warts

1, 2, 4, 7‡

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

Warts in kidney transplant patients

75–77

Often multiple and difficult to treat

HPV-associated mucosal and anogenital cancers

16 and 18 (most commonly), and 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68

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

* Affected women and female partners of affected patients should be frequently evaluated for cervical cancer.

Al-Awadhi R, Al-Mutairi N, Albatineh AN, Chehadeh W: Association of HPV genotypes with external anogenital warts: A cross sectional study. BMC Infect Dis 19(1):375, 2019. doi: 10.1186/s12879-019-4005-4

‡ Most often caused by subtypes that cause common warts.

HPV = human papillomavirus.

Some data adapted from Cubie HA: Diseases associated with human papillomavirus infection. Virology 445(1-2):21–34, 2013. doi: 10.1016/j.virol.2013.06.007