Multiple papillary lesions of the gingival

THE CHALLENGE A39-year-old man was referred by his dermatologist to an oral and maxillofacial pathologist (C.A.) for evaluation of multiple papillary lesions involving the facial and lingual surfaces of the maxillary and mandibular attached gingiva. The patient had been aware of multiple oral lesions for approximately one year and stated that they appeared initially at the angles of his mouth, affecting primarily the skin. He was unsure of the exact diagnosis for his condition, but he had been told it was “not cancer.” He reported that he had initially been treated by means of cryotherapy, followed by a seven-month course of imiquimod (applied topically every other night), which seemed to control the problem until he subsequently developed intraoral lesions. Recently, the patient had noted rapid growth of these lesions with occasional episodes of hemorrhage. The patient’s medical history was significant for chronic active hepatitis B, for which he recently had finished a four-month course of interferon alfa (5,000 units administered subcutaneously six days per week). Interestingly, the patient reported that his oral lesions seemed to regress during the interferon treatment and