Oral verrucous hyperplasia due to repetitive chewing on lips

F ifty-year-old male smoker presented with a slowgrowing raised lesion on the mucosal surface of his upper lip (Fig. 1). He underwent an excisional biopsy and pathology confirmed verrucous hyperplasia without evidence of malignancy as shown in Fig. 2. Patient made an uneventful recovery. The most common site of presentation involves the buccal mucosa (48%) followed by the tongue (20%), palate (18%), gingiva (7%), and labial mucosa (7%) (1). Causative factors include smoking cigarettes, smokeless tobacco, chewing habits, poor oral hygiene, and alcohol consumption. Clinically, oral verrucous hyperplasia (OVH) resembles verrucous carcinoma and these can generally only be distinguished from each other by histopathology. Although no consensus guidelines exist, the following criteria is proposed by Kallarakkal et al. for the diagnosis of verrucous hyperplasia (2):