Histological differential diagnosis for all types includes lesions of fibroepithelial hyperplasia: fibroepithelial polyps, fibrous epulis and papillary hyperplasia associated with candidal infection or dentures. These have a more prominent fibrous component and no viral change. Verruciform xanthoma is a solitary lesion with a very similar clinical and histologi-cal presentation.

Extensive multiple papillomas or diffuse papillomatous change raise the possibilities of HPV lesions in immunosuppression, acanthosis nigricans, naevus unius et lateris, focal dermal hypoplasia, Cowden syndrome, papillary and verru-

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