Skin Papilloma, also referred to as viral papilloma or filiform wart, is a benign neoplasm that rises above the surface of the skin. Viral papillomas typically begin to appear during adolescence, and as individuals age, these lesions tend to become more numerous. This type of neoplasm is characterized by its multiplicity, and the frequency of occurrence increases with age. Both congenital and acquired papillomas can be found, although in some cases, the viral etiology is absent.
The primary cause of papillomas is considered to be the human papillomavirus (HPV), which is generally associated with a low oncogenic risk. However, given that nearly 90% of the population carries the HPV virus but not everyone develops papillomas, it is evident that other factors contribute to the occurrence of these lesions on the skin. The following factors are known to increase the likelihood of developing papillomas:
The diagnosis of papillomas is based on a clinical examination, which includes a routine visual inspection of the lesions followed by dermatoscopy to examine the structure of the growths. In some cases, laboratory tests can be performed to detect HPV. If there is a concern that the papilloma may be malignant, a biopsy (excision biopsy) can be performed to confirm the diagnosis and rule out other conditions.
Upon visual inspection, a papilloma is recognized as an elongated formation that rises above the skin on a stem (pedicle). The stem can be as wide as the diameter of the papilloma or slightly narrower. The surface texture of the papilloma typically resembles that of normal skin, but larger papillomas may have a rough, warty surface with a “ragged” appearance.
The borders of the papilloma are generally clear, although they can be uneven, especially in larger lesions. The color of the papilloma usually varies from flesh-colored (most common) to light brown. Darker colors are rare in these lesions. Papillomas do not typically affect hair growth. In some cases, coarse bristly or fluffy hairs may be observed growing in the central part of the lesion.
The size of papillomas is usually small, with typical dimensions being up to 2-3 mm in width and 3-5 mm in height above the skin’s surface. Larger papillomas are uncommon. On palpation, the papilloma feels similar to normal skin or slightly softer, particularly in the central portion. There are no subjective sensations associated with the papilloma, although mild itching can sometimes occur in long-standing cases.
Papillomas are most commonly found on the neck, axillary regions, inguinal regions, and the trunk (chest and back), though they can also appear on mucous membranes. These lesions are less frequently found on other parts of the body.
During dermatoscopy, the following features of skin papillomas can be observed:
When diagnosing papillomas, they must be differentiated from other similar skin lesions, including:
In general, papillomas are benign and do not pose an increased risk of malignancy. In the absence of external influences such as trauma, ultraviolet radiation, or ionizing radiation, the risk of malignant degeneration is low and comparable to the risk of skin cancer in unchanged skin. However, if papillomas change in appearance, grow rapidly, or become denser, they should be evaluated by a dermatologist or oncologist, as these could be signs of malignant transformation.
Papillomas are more dangerous due to their tendency to become easily injured because of their elongated shape and narrow stalk. This can result in bleeding, pain, and the potential for infection, making the wound an entry point for harmful microorganisms. In addition, papillomas can cause cosmetic and psychological discomfort, especially if they are located in visible areas.
Because of the viral nature of papillomas, and given that many individuals carry HPV without showing symptoms, it is important to be vigilant about one’s health and to undergo regular medical check-ups to detect any signs of malignancy. Routine oncological examinations by specialists are recommended.
If the papilloma shows no signs of damage, change in appearance, or any symptoms, self-monitoring is typically sufficient. This should include an annual check-up or examination by another person for areas that are difficult to inspect. If mechanical injury, exposure to UV radiation, or ionizing radiation occurs, or if any changes are noticed, a visit to a dermatologist or oncologist is necessary.
The healthcare provider will assess whether ongoing monitoring or surgical removal of the papilloma is needed. Papillomas that experience constant trauma from clothing, jewelry, or from professional activities should be considered for removal to prevent further injury. In some cases, papillomas can be removed at the patient’s request, especially if they cause cosmetic concerns or psychological discomfort.
For dynamic observation, it is helpful to take photographs of the papillomas, as this allows for the detection of even minor changes over time. Patients with multiple papillomas should undergo regular dermatological examinations, particularly in the spring and autumn (before and after the summer sun exposure). Keeping a map of skin neoplasms can simplify the monitoring process and help identify new or changing lesions.
For the treatment of papillomas, less invasive methods are typically preferred:
If these less invasive treatments are not suitable, or if there is uncertainty regarding the nature of the papilloma, surgical excision with histological examination may be required.
Self-removal of papillomas is not recommended due to the risk of complications such as bleeding, infection, and misdiagnosis of the lesion’s nature.
Since papillomas are viral in nature, there is always a risk of recurrence. New papillomas may appear in the same or adjacent areas after removal. Preventative measures help reduce the likelihood of relapse.
Preventing the appearance of papillomas involves a careful and proactive approach to skincare and overall health:
It is also important to regularly inspect papillomas, seek timely consultation with a healthcare professional if any changes are observed, and remove potentially dangerous lesions to prevent complications.
