Skin - Nonmelanocytic tumors
Benign (nonmelanotic) epidermal tumors or tumor-like lesions
Verruca vulgaris

Reviewer: Hillary Elwood, M.D. (see Authors page)

Revised: 4 December 2015, last major update December 2015

Copyright: (c) 2003-2015, PathologyOutlines.com, Inc.

PubMed Search: Verruca vulgaris [title]
Definition / General
  • Also known as Common Wart (see also Warts)
  • Common human papillomavirus (HPV) infection of skin
Essential Features
Clinical Features
  • All ages can be affected, common in children and adolescents
  • Immunocompromised particularly susceptible
  • Many HPV types implicated, HPV type 2 most common
  • Rough hyperkeratotic to papillomatous skin colored or erythematous papule / plaque
  • Often multiple
  • Commonly on hands and feets
  • May have black dots within the lesion (correlating with thrombosed capillaries in dermal papillae)
Treatment
  • Often slow to respond to therapy
  • Some may regress spontaneously
  • Various therapies have been used
  • Common management options include observation, electrocautery, excision, cryotherapy, topical therapy (such as salicyclic acid, antharidin, podophyllin, tretinoin)
Clinical Images
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Verruca vulgaris

Micro Description
  • Well circumscribed exophytic growth with marked hyperkeratosis and papillomatosis
  • Rete ridges slope inward at borders of lesion
  • Prominent granular layer with vacuolated superficial keratinocytes with pyknotic nuclei (koilocytes)
  • Dilated blood vessels within papillary dermis
  • Tiers of parakeratosis overly papillary epidermal tips
  • Red blood cells often seen within parakeratotic tiers
  • May have lichenoid lymphocytic infiltrate, particularly in regressing verrucae
  • Areas resembling trichilemmoma may be at the base of some long standing warts
Micro Images

Images hosted on PathOut server:

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Verruca vulgaris, images c/o Dr. Hillary Elwood



Images hosted on Other servers:

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Parakeratosis

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Orthokeratosis

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Low power

Differential Diagnosis
  • Seborrheic keratosis:
    • No hypergranulosis, koilocytes, tiers of parakeratosis
    • Some benign lesions have intermediate overlapping features of verruca vulgaris and seborrheic keratosis, and may be termed "verrucous keratosis"
  • Squamous cell carcinoma:
    • May have a papillomatous architecture, but has the cytologic atypia, mitoses and infiltrative growth pattern of a carcinoma
  • Verrucous carcinoma:
    • This is mainly an issue in distinguishing from verrucae when the lesion is transected above the base
    • Deeper biopsies / excisions will show the classic deep bulbous downgrowths
    • Clinical history is important and verrucous carcinoma is worth considering in long standing lesions, particularly in genital or plantar locations, that are superficially transected at biopsy
  • Verruciform xanthoma:
    • At low power may have a verruca-like architecture with hyperkeratosis and papillomatous acanthosis
    • However, papillary dermis is filled with numerous xanthomatous cells