In the "store and forward" teledermatology modality, there is a transfer of patient medical information electronically (including history and visual data) obtained in one location to a provider in another location (Roman & Jacob, 2015). The construct of the Teledermatology ViewPoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report.
TELEDERMATOLOGY READER REPORT1
History
Chief complaint: presenting for diagnosis and therapeutic options.
History of present illness
A 7-year-old boy presents with an asymptomatic growth in his mouth. Prior treatment for skin condition: none. Prior biopsy: none.
IMAGE QUALITY ASSESSMENT
Fully satisfactory.
TELEDERMATOLOGY IMAGING READER REPORT
There is one image provided with this consult.
INTERPRETATION OF IMAGES
Lesion A
Findings
The presented lesion (see Figure 1) shows a round whitish papule with a smooth surface on the gingival mucosa just inferior to the lower midline incisors. See Figure 1.
The morphology, location, and history are most consistent with the diagnosis of an oral papilloma, with a benign epidermal fibroma also being in the differential diagnosis.
RECOMMENDATIONS
Referral to ear, nose, and throat or dental surgery for evaluation and potential biopsy.
RECOMMENDED FOLLOW-UP
Pending subspecialty consult evaluation.
CLINICAL PEARL
Oral papillomas (squamous papillomas) are benign proliferations of squamous epithelium of the oral mucosa, considered to be associated with human papilloma virus (HPV) infection (Hunt et al., 2017). HPV is a ubiquitous class of viruses with more than 100 subtypes, some of which are known to cause proliferative lesions on the skin and mucosa. Specifically, HPV subtypes 6 and 11 have been correlated with 50%-75% of HPV-associated oral lesions (Gillison et al., 2012; Hunt et al., 2017). Although sexual transmission has long been thought to be the primary mode of transmission of genital HPV, vertical transmission during childbirth has been reported (Syrjanen, 2010). There appears to be no predilection to gender (Allen & Woo, 2017).
Oral papillomas usually present as a small single painless rough papule and can be found anywhere in the mouth but are often located on the ventral tongue, frenum area, palate, and mucosal surface of the lips (Hunt et al., 2017). Lesions may develop small fingerlike projections resulting in a cauliflower-like surface (Testi et al., 2015). Biopsy is recommended to confirm the diagnosis. Untreated lesions are typically not malignant but, however, can be removed with surgical excision. Removal may be curative; however, recurrence or appearance of new lesions requires reevaluation.
NURSING PERSPECTIVE
Oral benign HPV-associated lesions are, for the most part, asymptomatic lesions and may be discovered on oral examination by a healthcare or dental provider. Because solitary small lesions are easiest to treat, they are often excised. It is noteworthy that they can potentially relapse spontaneously.
The Centers for Disease Control and Prevention recommends that children aged 11-12 years receive two doses of HPV vaccination, spaced at least 6 months apart. Adolescents aged 15-26 years not previously vaccinated are recommended three doses spaced 1-2 and 6 months apart from the first vaccination (Meites, Kempe, & Markowitz, 2016). Since 2016, only nine-valent HPV vaccines are sold in the United States, which protect against HPV types 31, 33, 45, 52, and 58 in addition to HPV types 6, 11, 16, and 18 virus-like particles (VLP), which had been included in previous versions of the HPV vaccine.
REFERENCES