Conjunctival Papilloma

In general, papilloma is a histopathological term describing tumors with specific morphology. They
take on a classic fingerlike or cauliflowerlike appearance. Papillomatous lesions often are lobulated
with a central vascular core. Irrelevant of its cytology, a neoplasm of epithelial origin with this form of
growth is also called papilloma. Papillomas can be benign or malignant and can be found in numerous
anatomical locations (eg, skin, conjunctiva, cervix, breast duct). Specifically, conjunctival papillomas
are benign squamous epithelial tumors with minimal propensity toward malignancy.
Conjunctival papillomas are categorized into infectious (viral), squamous cell, limbal, and inverted
(histological description) based on appearance, location, patient's age, propensity to recur after
excision, and histopathology. They demonstrate an exophytic growth pattern. Interestingly, inverted
papillomas exhibit exophytic and endophytic growth patterns.
Conjunctival papilloma also can be classified based on gross clinical appearance, as either
pedunculated or sessile. The pedunculated type is synonymous with infectious conjunctival papilloma
and squamous cell papilloma. The limbal conjunctival papilloma often is referred to as noninfectious
conjunctival papilloma because it is believed that limbal papillomas arise from UV radiation exposure.
Because of its gross appearance, limbal papillomas are typed as sessile. Although rare, inverted
conjunctival papillomas sometimes are referred to as mucoepidermoid papillomas because these
lesions possess both a mucous component and an epidermoid component.
A strong association exists between human papillomavirus (HPV) types 6 and 11 and the
development of conjunctival papillomas. Infectious conjunctival papillomas also are known as
squamous cell papillomas. This term arises from its histopathological appearance (ie, the lesion is
confined to the epithelial layer, which is acanthotic).

Contents
[hide]

1 Disease Entity

1.1 General Pathology

1.2 Pathophysiology

1.3 History

1.4 Physical examination

1.5 Signs

1.6 Differential diagnosis

2 Management
o

2.1 Medical therapy

2.2 Surgery

2.3 Surgical follow up

2.4 Prognosis
3 Additional Resources
4 References

Disease Entity
Epidemiology
Frequency
United States
Literature reviewed yielded no published study outlining the prevalence of conjunctival papillomas in a
cross section of a population. Interestingly, studies are numerous for extraocular sites. Prevalence of
conjunctival papillomas ranged from 4-12%. A strong association exists between HPV and squamous
cell papilloma. Moreover, the HPV genome is identifiable in most conjunctival papillomas and in 85%
of conjunctival dysplasias and carcinomas.
Although no cross-section epidemiological studies are available, evidence suggests that people
without overt clinical presentation may harbor the virus, and HPV DNA can be identified in
asymptomatic conjunctiva. HPV types 6 and 11 are the most frequently found in conjunctival
papilloma. HPV type 33 is another source in the pathogenesis of conjunctival papilloma. HPV types
16 and 18 commonly are associated with not only high-grade cervical intraepithelial neoplasia and
invasive carcinoma but also squamous cell dysplasia and carcinoma of the conjunctiva. The
recurrence rate for infectious papillomas is high. Limbal papillomas have a recurrent rate of 40%.

Mortality/Morbidity
Conjunctival papillomas (squamous cell, limbal, or inverted) are not life threatening. Conjunctival
papillomas may be large enough to be displeasing or cosmetically disfiguring. HPV types 6 and 11

may be transferred to the child during parturition from an infected birth canal resulting in ocular
symptoms.
Egbert et al reported a case of conjunctival papilloma in an infant born to a mother with HPV infection
of the vulva during pregnancy.[4] Those infected at birth may later develop respiratory papillomatosis,
which may be life threatening. Direct contact with contaminated hands or objects may result in ocular
manifestations.
Squamous cell papilloma, which has an infectious viral etiology, has the propensity to recur after
medical and surgical treatment. New and multiple lesions may arise after excision. Recurrent
conjunctival papillomas may extend into the nasolacrimal duct causing obstruction. Lauer et al and
Migliori and Putterman reported a case of nasolacrimal duct obstruction after extension of the
papillomas into the lacrimal sac.[5, 6] Most papillomas are benign. Rarely, they can undergo
malignant transformation, signs of which include inflammation, keratinization, and symblepharon
formation.

Age
Squamous cell papillomas (ie, infective papilloma, viral conjunctival papilloma) are seen commonly in
children and young adults, usually younger than 20 years. Because HPV is associated strongly with
this form of papilloma, siblings, including twins, also may be affected. Limbal papillomas are seen
commonly in older adults. A slight association exists between UV radiation and limbal conjunctival
papilloma.

General Pathology
Histologic Findings
Squamous cell papillomas (eg, infectious papilloma, viral conjunctival papilloma) are composed of
multiple branching fronds emanating from a narrow pedunculated base. Individual fronds are
surrounded by connective tissue, each having a central vascularized core. Acute and chronic
inflammatory cells are found within these fronds. The epithelium is acanthotic, nonkeratinized
stratified squamous epithelium without atypia. Numerous goblet cells are seen along with acute
inflammatory cells. Koilocytosis is exhibited. The basement membrane is intact.
Limbal papillomas are sessile lesions arising from a broad base with a gelatinous appearance.
Corkscrew vascular loops and feeder vessels are seen. The epithelium is acanthotic, displaying
varying degrees of pleomorphism and dysplasia. The epithelium surface may be keratinized with foci
of parakeratosis within the papillary folds. The basement membrane is intact.
Inverted papillomas exhibit exophytic and endophytic growth patterns. Invagination into the underlying
stroma instead of the exophytic growth pattern is exhibited by squamous cell or limbal papillomas,

whereas some lesions exhibit a mixture of exophytic and endophytic growth patterns. Unlike inverted
papilloma arising in the lateral nasal wall or paranasal sinuses, lesions arising from the conjunctiva
tend to be less aggressive in malignant transformation. The lesions are composed of lobules of
epithelial cells extending down into the stroma. The lesion may be elevated or umbilicated. Epithelial
cells do not demonstrate atypia, and dysplastic changes are uncommon for conjunctival inverted
papillomas. The cytoplasm is vacuolated in some cells. They may resemble squamous papilloma or
pyogenic granuloma. Numerous goblet cells are intermixed with the epithelium. Cysticlike lesions may
be seen secondary to the confluence of goblet cells. The lesion may contain melanin granules and/or
melanocytes.

Pathophysiology
Human papillomavirus (HPV) and polyomavirus are members of the Papovavirus family. These
viruses are small (55 nm), naked, and icosahedral with circular double-stranded DNA. Papilloma
viruses exhibit site and cell-type specificity, as follows:

HPV 6 and 11 Benign skin warts or condylomas of the female genital tract and conjunctival
papilloma
HPV 16 and 18 Cervical carcinoma
HPV 6a and 45, two new subtypes, have been reported to be associated with conjunctival papilloma.
[1, 2]
Transmission is via direct human contact. Proliferation of dermal connective tissue is followed by
acanthosis and hyperkeratosis. HPV is tumorigenic, and it commonly produces benign tumors with
low potential for malignancy. In general, prolonged proliferation may lead to cellular atypia and
dysplasia. HPV type 11 was the most common and frequently found in conjunctival papilloma as
analyzed by polymerase chain reaction (PCR).[3]

History
General approach

A good ocular history is not only essential but also critical in making the correct diagnosis.

Knowing the patient's age and the anatomical location of the tumor or tumorlike lesion (eg,
inverted papillomas [Schneiderian or mucoepidermoid papillomas] typically involve the mucous
membrane of the nose, paranasal sinuses, and lacrimal sac) is helpful for the ophthalmologist.
The conjunctiva is rarely affected.

A change in size and shape should raise the index of suspicion for a possible neoplastic
proliferation. However, other reasons may contribute to the change in size. Cystic lesions may
increase in size secondary to accumulation of fluids and/or acellular debris. An inflammatory
response may cause a benign lesion to increase in size.

Most conjunctival tumors are isolated lesions. However, in a small percentage, conjunctival
lesions may be an extension of systemic disease (ie, Lhermitte-Duclos disease, Cowden
syndrome).

A history of congenital, bilateral, or multifocal conjunctival lesions strongly suggests an

underlying systemic disease. Therefore, a profound systemic workup is warranted.

History associated with conjunctival papilloma

Squamous cell papilloma

Usually seen in younger patients

History of maternal HPV infection at the time of parturition

A past history of tumor excision with recurrence

Refractive to past medical and surgical treatments

No decrease or loss of visual acuity

A history of a sibling with the same condition

A history of cutaneous warts at extraocular sites

Limbal papilloma

Seen in older adults

History of UV exposure

Possible decrease or loss of visual acuity

Recurrence after excision, not common

History of chronic conjunctivitis refractive to medications

Physical examination

Key features to assist an ophthalmologist in examining a surface tumor include the following:
Tumor location: Knowing the probability of finding a tumor in a specific anatomical location greatly
assists the ophthalmologist not only in making the diagnosis but also, and more importantly, in
prioritizing the differential diagnosis.

Approximately 25% of all lesions involving the caruncle are papillomas.

Squamous cell carcinoma is seen commonly in the interpalpebral zone adjacent to the limbus
and rarely appears elsewhere. Although possible, a diagnosis of squamous cell carcinoma would
be questionable if remote from the limbus.

Tumor color: Tumor color provides important clues and clinical judgment based on the following:

Pigmented lesions suggest a melanocytic origin.

Salmon-colored lesions are associated with lymphoid tumors.

Pale or dull yellow lesions are associated with xanthomas.

Tumor topography: In evaluating, attention should be made to the tumor's surface, to include the
tumor's texture and edge.

The conjunctiva surface appearance is altered predictably in epithelial tumors (ie, the surface
epithelium is raised, cobblestone, and/or acanthotic).

In differentiating from epithelial tumors, tumors arising from the substantia propria tend to
have a smooth epithelial surface.

Tumor edges between normal conjunctiva and diseased conjunctiva may appear abrupt, as
seen in conjunctival papilloma or conjunctival intraepithelial neoplasia (CIN).

In cases where the edges are ill defined, lymphoid tumors should be considered.

Tumor growth pattern: The pattern of growth may be described as solitary, diffuse, or multifocal.

Solitary growth is seen in conjunctival papilloma.

Diffuse growth, although rare, is associated with conjunctival intraepithelial neoplasia,

sebaceous carcinoma (pagetoid spread), lymphoma, and reactive lymphoid hyperplasia.

Tumor consistency: The tumor consistency can be described as solid, soft, or cystic.

Tumor consistency is established by palpation, which is useful in evaluating and diagnosing

subepithelial tumors.

Palpation is performed under topical anesthesia during the slit lamp examination, using a
cotton-tip applicator.

This technique is beneficial in determining whether an epithelial tumor has invaded the
underlying supporting tissue. Most papillomas are freely mobile over the sclera. An epithelial
tumor that has already invaded the underlying connective tissue will feel fastened to the globe
when tenderly pushed from side to side.

Signs
Clinical signs associated with squamous cell papilloma (infectious papilloma) are as follows:

This lesion is benign and self-limiting.

It is seen commonly in children and young adults.

Most lesions are asymptomatic without associated conjunctivitis or folliculitis.

Anatomically, it commonly is located in the inferior fornix, but it also may arise in the limbus,
caruncle, and palpebral regions.

The lesion may be bilateral and multiple.

Grossly, squamous cell papilloma appears as a grayish red, fleshy, soft, pedunculated mass
with an irregular surface (cauliflowerlike).

Clinical signs associated with limbal papilloma are as follows:

This lesion is typically benign.

It is seen commonly in older adults.

Anatomically, the lesion commonly occurs at the limbus or the bulbar conjunctiva.

These lesions may spread centrally toward the cornea or laterally toward the conjunctiva.

Visual acuity may be affected if the lesion grows centrally.

These lesions almost always are unilateral and single.

They tend to have variable proliferation potential with a tendency to slowly enlarge in size.

Clinical signs associated with inverted conjunctival papilloma are as follows:

This lesion is slow growing and is seen commonly in the nose, paranasal sinuses, or both.
The lacrimal sac and the conjunctiva are uncommon sites.

The lesion is unilateral and unifocal and does not recur after surgical excision.

Differential diagnosis
1. Ichthyosis
2. Sebaceous Gland Carcinoma
3. Conjunctival Squamous Cell Carcinoma

Management
Observation and patient reassurance are indicated for squamous cell papillomas. These lesions may
regress spontaneously over time. Seeding may follow excision, resulting in multiple new lesions. For
limbal papillomas, excision is indicated to rule out neoplastic changes.
Cryotherapy is indicated for squamous cell papillomas. Less scarring occurs, and the recurrence rate
is low. It is not indicated for limbal papillomas because this procedure does not distinguish between
benign papillomas and malignant papillomas. The double-freeze-thaw method is preferred and
appears to be the most effective technique.
Dinitrochlorobenzene (DNCB): Petrelli et al demonstrated success with DNCB in the treatment of
recurrent conjunctival papillomas.[7] This treatment modality is reserved for cases when surgical
excision, cryoablation, and other treatment modalities have failed. The patient is sensitized to DNCB.
Once sensitized, DNCB is applied directly to the papilloma. The mechanism for this treatment appears
to be the delayed hypersensitivity reaction causing the tumor to regress; however, the exact
mechanism is unknown.
Interferon is an adjunct therapy to surgical excision of recurrent and multiple lesions. Alpha interferon

is given intramuscularly (daily for 1 mo, 2-3 times/wk for the next 6 mo, then tapered off). Lass et al
indicated both nonrecurrence and recurrence of conjunctival lesions.[8] However, those recurring
lesions tend to be less severe in clinical presentation. Because of its antiviral and antiproliferative
properties, this form of therapy is designed to suppress tumor cells; it is not curative. Additionally,
topical interferon alpha-2b has been shown to be an effective adjunct therapy for small-to-medium
size lesions but not for large lesions without surgical debulking. Topical interferon alpha-2b can be
utilized as an adjunctive therapy for recurring conjunctival papilloma.[9, 10] More recently, topical
alpha-2b interferons have shown to be successful in treating not only primary conjunctival papilloma
but also conjunctival intraepithelial neoplasia.[11]
Mitomycin-C is an adjunct therapy to surgical excision. Mitomycin-C is indicated for recalcitrant
conjunctival papillomas or those refractive to past multiple treatments. Hawkins et al reported
complete regression of conjunctival papilloma 9 months after surgical excision followed by
intraoperative mitomycin-C application.[12] Mitomycin-C (0.3 mg/mL) is applied via a cellulose sponge
to the involved area(s) after surgical excision. The sponge is held in place for 3 minutes. The treated
area is irrigated copiously with normal saline after mitomycin-C application. Complications include
symblepharon, corneal edema, corneal perforation, iritis, cataract, and glaucoma.
Oral cimetidine (Tagamet): Although commonly used to treat peptic ulcer disease, cimetidine has
shown to be effective in the treatment of recalcitrant conjunctival papilloma. Shields et al
demonstrated dramatic tumor regression with nearly complete resolution in an 11-year-old boy treated
with cimetidine.[13] Chang et al indicated that oral cimetidine can be used as an initial treatment
modality in cases where the lesion is quite large and recalcitrant.[14] Apart from its antagonistic effect
on H2 receptors, cimetidine has been found to enhance the immune system by inhibiting suppressor
T-cell function and augmenting delayed-type hypersensitivity responses.
Carbon dioxide (CO2) laser: Schachat et al and Jackson et al reported this treatment modality to be
safe and most effective.[15, 16] It is indicated for recalcitrant conjunctival papillomas. The procedure
is performed easily. This procedure allows for precise tissue excision with minimal blood loss and
trauma to tissue. Rapid healing of tissues occurs without significant scarring, edema, or symblepharon
formation. Recurrence is low, resulting from the destruction of viral particles and papillomatous
epithelial cells. Gentamicin ointment twice a day for 7-10 days is prescribed postoperatively to allow
proper healing and reepithelialization.
Other treatment modalities include electrodesiccation, topical acids, topical cantharidin, and
intralesional bleomycin.

Excision is indicated for squamous cell and limbal papillomas.

Performing an excisional biopsy is recommended for adults to rule out premalignancy

changes.

In the pediatric population, performing an excisional biopsy is less clear. This is a surgical
procedure requiring general anesthesia. To justify the risk of anesthesia, this procedure is
indicated in cases where the lesion is causing significant symptoms, (ie, cosmetically disfiguring,
has not regressed, appearance of new lesion).

An excisional biopsy is preferred to an incisional biopsy whenever possible.

Medical therapy
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
1. H2-receptor antagonists (Cimetidine)
2. Immune Modulators (Dinitrochlorobenzene)
3. Interferon (Interferon alpha-2b)
4. Antineoplastic agents (mytomycin-C)

Surgery
Biopsy (incisional or excisional) is a reasonable and safe method that aids in obtaining a definitive
diagnosis. Indications for a biopsy are as follows:

To rule in or to rule out the possibility of malignancy

For lesions not obviously benign (symptomatic and/or show growth)

For neoplasms suggestive of malignancy (HIV-positive patients or chronic unilateral

conjunctivitis unresponsive to therapy)

Therapeutic decision

To determine the surgical margin in ill-defined lesions

To exclude the possibility of recurrent neoplastic changes

To harvest tissue for special studies (ie, flow cytometry)

Frozen section

The most common indication for a frozen section is to determine whether surgical margins are
free of tumor (ie, to assess the adequacy of tissue excision).

A frozen section should not be used for an "on-the-spot" diagnosis, since frozen tissue
rendered tissue morphology is less optimal for microscopic examination.

Invasive disease can be excluded, but intraepithelial lesions may not.

Conjunctival tissue tends to curl after excision; therefore, it is best to examine after fixation
and inking the borders. After obtaining the biopsy, place the tissue flat on a piece of firm
paper/cardboard before placing in fixation medium.

Surface tissue sampling

Exfoliative cytology (tissue scraping)

This technique is used commonly to aid in the diagnosis of cervical disease. However, this
technique and its role in aiding the ophthalmologist in diagnosing ocular surface lesions are less
well defined.

Major limitations include the possibility of false-negative results and its inability to determine
the depth of invasion.

Most benign and inflammatory lesions cannot be identified precisely by cytologic methods.

It is useful as a guide for where to obtain a biopsy specimen or resect ill-defined conjunctival
lesions.

Impression cytology

Another technique for collecting surface cells, impression cytology uses a cellulose acetate
filter paper. When the filter paper is placed in direct contact with the surface cells, the cells adhere
to the paper.

Impression cytology is less traumatic than exfoliative cytology.

Intracellular structures are better preserved than with exfoliative cytology.

Limitations are similar to exfoliative cytology; both are not appropriate for identifying
intraepithelial tumors.

Surgical follow up
For patients who undergo cryoablation, CO2 laser, or surgical excision for conjunctival papilloma,
posttreatment follow-up care is usually at 5 days, at 1 month, and then at 1 year.
Patients on a medical regimen should receive monthly follow-up care for possible adverse effects until
the medication is discontinued. Then, these patients should receive annual follow-up care to check for
recurrence of the lesion.

Prognosis
The prognosis for patients with this condition is generally good.

Recurrences of viral papillomas are not uncommon.

Recurrences of completely excised squamous cell papillomas are uncommon.

Patients should receive routine follow-up care for recurrences.

Additional Resources
Inform patients that the lesion may recur after excision and that multiple recurrences are not
uncommon.
Recurrence of lesions may require more aggressive treatment.
Theoretically, decreasing sun exposure may prevent squamous cell lesions.

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Veruca vulgaris Benign epithelial hyperplasia caused by infection with the papilloma virus of the
papova group. Early verrucae are usually round, discrete, skin-coloured, and pinpoint in size. With
time they grow to larger yellowish, greyish-black or brown lesions with a roughened papillomatous
surface. Verrucae are spread by direct or indirect contact. Since local trauma promotes inoculation
of the virus, most warts are seen on the fingers, hands, and elbows, along the perionychial folds,
or on the plantar surfaces of the feet. They are seen in patients of all ages but generally occur
during childhood and adolescence. Histopathologic examaniation of verruca vulgaris reveals a
markedly and papillomatous epidermis with hypergranulomatosis and overlying tiers of
parakeratosis (figure 1).
The upper epidermis may contain large pink inclusions (figure 2), particularly in cases arising on
acral skin. Other lesions show smaller basophilic granules (figure 3). Characteristic vacuolated
keratinocytes (koilocytes), which have a small shrunken nucleus surrounded by a perinuclear
halos, are seen in the upper epidermis (figure 3).

Verruca vulgaris pathology

Figure 1

Figure 2

Figure 3

What Is Molluscum
Contagiosum?
Molluscum contagiosum is a skin infection that is caused by a virus. The
virus, called the molluscum virus, produces benign raised lesions, or
bumps, on the upper layers of your skin.
The small bumps usually are painless. They disappear on their own and
rarely leave scars when left untreated. The length of time the virus lasts
varies for each person, but the bumps can last from two months up to four
years.
Molluscum contagiosum is spread by direct contact with the lesion of an
infected person or by contact with a contaminated object such as towels
or piece of clothing.
Medication and surgical treatments are available, but in most cases,
treatment is not necessary. The virus can be more difficult to treat if you
have a weakened immune system.

Part 2 of 9: Causes

Causes of Molluscum
Contagiosum

You can contract molluscum contagiosum by touching the lesions on the

skin of an infected person. Children can contract the virus during normal
play with other children.
Teens and adults are more likely to become infected through sexual
contact. You can also become infected during contact sportssuch as
wrestling or footballthat involve bare skin interactions.
The molluscum virus can survive on surfaces that have been touched by
the skin of an infected person. Therefore, its possible to contract the virus
by handling towels, clothing, toys, or other items that have been
contaminated.
Molluscum contagiosum also can be transferred by shared sports
equipment where an athletes bare skin comes in contact with the object.
The virus can be left and passed to the next person on items such as
baseball gloves, wrestling mats, and football helmets.
If you have this condition, you can spread the infection throughout your
body. You can transfer the virus from one part of your body to another by
touching, scratching, or shaving a bump and then touching another part of
your body.

Part 3 of 9: Risk Factors

Risk Factors for Molluscum

Contagiosum
While no one is entirely risk-free molluscum contagiosum, certain groups
are more likely to become infected than others. They are:

children between the ages of 1 and 10

residents of tropical climates

individuals with weakened immune systems caused by factors such

as HIV, organ transplants, or cancer treatments

patients who have atopic dermatitis, a common form of eczema

that causes scaly and itchy rashes

athletes who participate in contact sports such as wrestling or

football, in which bare skin-to-skin contact is common

Part 4 of 9: Symptoms

Symptoms of Molluscum
Contagiosum
If you or your child comes in contact with the molluscum virus, you may
not see symptoms of infection for up to six months. The average
incubation period is between two and seven weeks.
You may notice the appearance of a small group of painless lesions. These
bumps may appear alone or in a patch of as many as 20. They usually are:

very small, shiny, and smooth in appearance

flesh-colored, white, or pink

firm and dome-shaped with a dent or dimple in the middle

filled with a central core of waxy material

between 2 millimeters (the size of the head of a pin) and 5

millimeters (the size of an eraser on the top of a pencil) in diameter

found anywhere except on the palms of your hands or the soles of

your feet

usually present on the face, abdomen, torso, arms, and legs

located on the inner thigh, genitals, or abdomen in adults

However, if you have a weakened immune system, you may have
symptoms that are more significant. Lesions may be as large as 15
millimeters in diameter, which is about the size of a dime. The bumps
appear more often on your face and are typically resistant to treatment.

Part 5 of 9: Complications

Complications of Molluscum
Contagiosum
Most complications of molluscum contagiosum are secondary skin
infections. These infections are caused by bacteria and may cause pain,
soreness, or inflammation.
Removing the bumps by scratching, or having them removed by a
physician usingcryotherapy (freezing) or curettage (scraping)
techniques can result in pain, irritation, or permanent scarring.

Part 6 of 9: Diagnosis

Diagnosis of Molluscum
Contagiosum
Because the skin bumps caused by molluscum contagiosum have a
distinct appearance, your physician often can diagnose the infection by
merely looking at the affected area. A skin scraping or biopsy can confirm
the diagnosis.
While it is usually unnecessary to treat molluscum contagiosum, always
have your physician examine any skin lesions that last longer than a few
days. Confirm the diagnosis of molluscum contagiosum to rule out other
causes for the lesions, such as skin cancer,chickenpox, or warts.

Part 7 of 9: Treatment

Treatment of Molluscum
Contagiosum
In most cases, if you have a normal immune system, it will not be
necessary to treat the lesions caused by molluscum contagiosum. The
bumps will fade away without intervention.

However, some circumstances may justify the need for treatment. If your
lesions are large and located on your face and neck, if you have an
existing skin disease such as atopic dermatitis, or if you have serious
concerns about spreading the virus, you might be a candidate for
treatment.
The most effective treatments for molluscum contagiosum are performed
by a healthcare provider and include:

cryotherapyliquid nitrogen is used to freeze each bump

curettagea small tool is used to pierce the bump and scrape it off
the skin

laser therapya laser is used to destroy each bump

topical therapycreams containing acids or chemicals are applied

to the bumps to induce peeling of the top layers of the skin
In some cases, these techniques can be painful and cause scarring.
Anesthesia may also be necessary.
Since these methods involve treating each bump, a procedure may
require more than one session. If you have many large bumps, retreatment may be necessary every three to six weeks until the bumps
disappear. New bumps may appear as the existing ones are treated.
In some cases, your physician may prescribe the following medications:

trichloroacetic acid,

topical podophyllotoxin cream (such as Condylox), which is derived

from plant resins

cantharidin (Cantharone, obtained from the blister beetle), applied

by the doctor,

imiquimod (Aldara), a topical cream that works by boosting the

immune system (Although this drug is currently approved only for

treatment of genital warts, it has been found to be effective against MC

and can be applied at home.)

cimetidine (Tagamet), the antiulcer and antiheartburn medication

(This drug has been reported to be useful in the treatment of MC.
However, the FDA for the treatment of MC has not officially approved it.)

cidofovir (Vistide), used through IV for eye infections in people

with AIDS (This drug has been shown to be effective when applied
topically to severe MC lesions. However, it has not officially been
approved by the FDA for the treatment of MC.)
If you are pregnant or are planning to become pregnant, or if you
are breastfeeding, let your physician know about your condition
before taking these or any other medications.
If you have an immune system that is weakened by diseases such as HIV
or by drugs such as those used for treating cancer, it may be necessary to
treat molluscum contagiosum. Successful treatment is more difficult for
people with weakened immune systems than it is for those with normal
immune systems.
Antiretroviral (anti-HIV) medications are the most effective treatment for
HIV patients infected with molluscum contagiosum because these
medications can work to strengthen the immune system to fight the virus.
The Centers for Disease Control and Prevention (CDC) warns against selftreatment of molluscum contagiosum without the advice of a healthcare
provider. According to the CDC,treatments available from online
sources may not work. They can even harm, rather than help,
your condition (CDC).

Part 8 of 9: Outlook

Long-Term Outlook for

Molluscum Contagiosum

A molluscum contagiosum infection will usually go away on its own if your

immune system is healthy. Typically, this happens graduallywithin six to
12 monthsand without scarring. However, for some, it may take from a
few months up to a few years for your bumps to disappear. The infection
can be more persistent and last even longer for people with immune
system problems.
Once the lesions fade, the molluscum virus is no longer present in your
body. When this happens, you cant spread the virus to others or to other
parts of your body. You will see more bumps only if you become infected
again. Unlike with chickenpox, if you have had molluscum contagiosum
once, you are not protected against being reinfected.

Part 9 of 9: Prevention

How to Prevent the Spread of

Molluscum Contagiosum
The best way to avoid getting molluscum contagiosum is to avoid
touching the skin of another person who has the infection. In addition,
these suggestions can help you prevent the spread of the infection:

Practice effective hand washing with warm water and soap.

Instruct children in proper hand-washing techniques since they are

more likely to use touch in play and interaction with others.

Avoid sharing personal items such as towels, clothing, hair brushes,

or bar soaps.

Avoid using shared sports gear that may have come in direct
contact with an athletes bare skin.

Avoid picking at or touching areas of your own skin where the

bumps exist.

Keep the bumps clean and covered to prevent yourself or others

from touching them and spreading the virus.

Avoid shaving or using electrolysis where the bumps are located.

Avoid sexual contact if you have bumps in the genital area.

Definition
By Mayo Clinic Staf

Molluscum contagiosum (mo-LUS-kum kun-tay-jee-OH-sum) is a relatively common

viral infection of the skin that results in round, firm, painless bumps ranging in size
from a pinhead to a pencil eraser. If the bumps are scratched or injured, the infection
can spread to surrounding skin.
Though most common in children, molluscum contagiosum can afect adults as well
particularly those with weakened immune systems. In adults, molluscum
contagiosum involving the genitals is considered a sexually transmitted infection
(STI).
Molluscum contagiosum spreads through direct person-to-person contact and
through contact with contaminated objects. The bumps associated with molluscum
contagiosum usually disappear within a year without treatment but doctor-assisted
removal is also an option.