The many-faced “papilloma”
Rarely would you meet a person who has not, or has not seen, or has not heard about papillomas. What is it, papilloma, such a common customer of our skin?

You may be very surprised to know that this term is now not in use in professional medical language. The word “papilloma” is a general notion covering all true benign tumors of epidermis (external layer of the skin), which are similar to papillae, as well as all its malformations and reactive excrescences caused by a chronic irritation or traumatizing. A pre-cancer, or an intraepidermal cancer may also hide themselves behind a mask of “papilloma”.

So, let us look at papillomas closer and learn more about their multiple faces.

Papillomas may be inborn or acquired, multiple or solitary. If papillomas are small, multiple, not merging between them and located predominantly at the neck or in armpits, then they are most likely of viral nature. Today, there are more than 70 types of papillomaviruses described, some of them proven not only to give rise to papillomas but even to provoke a malignant degeneration of cells. Human papillomaviruses are also pathogens of warts (which deserve a special discussion) and pointed condylomas (which resemble cauliflowers in appearance and prefer to spring up at the genitals area). To prevent reappearance of these new formations after their removal, it is recommended to process the skin surface with special antiviral preparations. The patients who are fond of neck-chains subject themselves to more quick and recurrent development of papillomatosis (multiple papillomas). When multiple papillomas are merged in a conglomerate of a mainly linear form and if they appear soon after birth or during the first years of life, then you have a limited epidermal papillomatous formation, or keratous (epidermal) nevus. Rarely it degenerates; and, if it does not make a major discomfort, may be left without intervention. 

And if the papilloma is single?
In such a case, there are more serious reasons for anxiety and for many diagnoses suggested. Keratopapilloma, or senile keratosis, may appear not only in old age, but also after 35–40. This malformation may be quite benign but, given the high risk of cancer, it is considered as suspicious case (pre-cancer). Keratopapilloma is most often situated in open areas of the body, which are more often subject to sunburn (face, shoulders, back of hand). Dry and compact dun scabs on its surface are the main reason to differentiate the keratopapilloma from viral one.

Acrochordon, or skin horn, is a variety of senile keratosis – a small salient tag of skin consisting of a dense horny masse. Acrochordon and senile keratoma are considered as pre-cancerous formations, which often lead to development of basal cell or squamous cell carcinomas.

A characteristic feature of a fibropapilloma is its hardened consistence and a “stalk”. If the formation is rather soft and attached to the skin by a stalk, then it is the most likely a fibrolypopapilloma containing a fatty tissue. Fibropapillomas as well as fibrolypopapillomas never degenerate to malignant tumors, rarely relapse, and yield easily to treatment.  

In the second half of life, basal cell papillomas (senile or seborrheic warts) may also appear. In contrast to keratopapillomas, they appear mainly in covered areas of the body and on the face. Basal cell papillomas are small solitary (more seldom multiple) mushroom-like or flat formations of dark color and round or oval shape, with rough and sebaceous surface. Seborrheic warts must be absolutely differentiated from pigmented nevi and melanomas.
 
When suspecting some form of papilloma, it is also necessary to differentiate it from keratoakanthoma, which, in contrast to all slow-growing papillomas, develops rapidly, prefers to site on hands and face, and has bright clinical features.

All sorts of papilloma yield easily to treatment such as electrocoagulation, freezing, surgical excision, and laser removal. Any of these methods is effective – in skilled hands, of course. Choosing a particular method, we use an individual approach, depending on site, form, and depth of the tumor. To avoid vain anxiety and to recognize a malignant tumor in proper time, a histological inspection of removed tissues must be done.  Dermatopathologist who examines the tissue sampling of the patient skin has to make certain that the new malformation is removed completely. If any part of the tumor is still there, than a wider and deeper excision is necessary involving healthy tissues around.
We hope that the above information will make easier your meeting with papilomas; if you like to learn more, we invite you to attend seminars at our Clinic.

Pointed condylomas
(Synonyms: viral papillomas; pointed warts; genital warts; verruca [condyloma] acuminatum)
Soft, fleshy or tread-like warts of skin color emerge on the skin or mucous tunic surface at the mouth or genitals areas. The pathogenic organism is human papillomavirus. As a rule, multiple condylomas are situated closely to each other and look like cauliflowers. The most often patients are young people in sexual activity.

The infection occurs by immediate contagion including sexual intercourses (90 to 100 per cent of sexual partners pick up the virus). The disease may grow and develop from several weeks to several years. The clinical presentation is sufficient to set the diagnosis, which may be confirmed, if necessary, by biopsy. For the treatment, we practice cryosurgery, laser removal, or radiosurgery.

Bowenoid papulosis
Occurs predominantly at the age of 20 to 40. Contagion in sexual way. The disease grows and develops from several weeks to several years. It affects skin and mucous tunics.
The appearance is quite benign: red, sometimes hyperemic flat papullae up to several millimeters in diameter; they may merge into skin plates. Such elements have smooth and velvety surface.
The disease has three possible scenarios of development: spontaneous recovery, dragging on for many years, and degeneration into a squamous cell carcinoma.

The treatment: electrocoagulation, cryosurgery, laser therapy, and surgical removal.

Soft fibroma
Affects middle and old age, more often women and obese people. Typical localizations are skin folds (axillary creases, folds under mammary glands) as well as neck and eyelids.
The fibroma is a soft peduncular polyp of circular or oval form and of normal skin-like, fawn, or umber color. Its size varies between 1 and 10 mm.
Usually, the tumor does not disturb the patient; but in case of torsion of the tumor pedicle, it becomes painful or bleeding. Fibromas increase in number during gestation.
Treatment methods: excision, cryosurgery, radiosurgical removal.

Warts
Affect all ages. The contagion occurs in contact way, through touching the affected skin. Untreated warts last for years. Warts are dense, round papullae 1 to 10 mm in size. Their surface is covered with chaps, corneal overlayers and vegetations. Typical localizations are hands and feet. Plantar warts tend to be painful.

Flat warts are strictly bordered papullae with smooth surface, 1 to 5 mm in diameter and eminent for 1 or 2 mm above the skin surface. The color of such formations is hazel, pink, or normal skin. If multiple, such elements are always situated by close groups. The treatment may involve cryosurgery, electrocoagulation, laser therapy and other methods. Some warts disappear all by themselves, without treatment.

Contagious mollusc
The most often affects children and adults leading active sexual life.
The contagion occurs when affected skin comes in touch with the healthy. The eruptions are white pearly or pink papullae, each having a navel-like hollow in its center. The elements are separate and scattered in disorder. Localization: face, neck, abdomen, perineum, external genitals.
Treatment: scraping off with a special sharp curette. Cryosurgery and electrocoagulation are also applicable. Sometime the disease passes by its own, without intervention.