Human papillomavirus and Epstein–Barr virus associated conditions of the oral mucosa

Human papillomavirus (HPV) and Epstein-Barr virus (EBV) infections of the oral mucosa may present as both benign and malignant conditions. Squamous papilloma, verruca vulgaris, and condyloma acuminatum are benign, HPV-associated growths treated with simple excision while multifocal epithelial hyperplasia (Heck disease) usually occurs in children and adolescents and resolves over time. HPV-associated oral dysplasia is uncommon and HPV-carcinoma comprises 6% of oral squamous cell carcinomas. EBV is responsible for oral hairy leukoplakia, a benign condition seen in immunocompromised patients, while the EBV-associated mucocutaneous ulcer is a recently-described, indolent condition associated with an atypical lymphoid proliferation seen immunocompromised patients as well as older adults, the latter likely because of immunosenescence. Awareness of these conditions is important for the practicing pathologist because some of these conditions may represent the first sign of underlying immunocompromise.