The histologic spectrum of epidermodysplasia verruciformis

The classic histologic presentation of epidermodysplasia verruciformis is a verruca plana-type lesion with minimal hyperkeratosis and acanthotic areas where the cells contain perinuclear halos and blue-gray pallor. Whereas th ese lesions have a high malignant potential, it is important to elucidate t he histologic spectrum of this entity and to differentiate it from its mimi cs. Fifteen skin biopsies from people with multiple cutaneous warts clinica lly suspicious for epidermodysplasia verruciformis were analyzed both histo logically and for human papillomavirus (HPV) deoxyribonucleic acid (DNA) by in situ hybridization. Ten of the lesions contained HPV DNA, either type 5 (n = 6), type 8 (n = 3), or type 51 (n = 1). Only three of these lesions s howed typical verruca plana. The histologic marker of HPV DNA in the other seven viral-positive cases was rare perinuclear halos in association with a n irregular granular layer. The other five cases, which were also negative for viral DNA after polymerase chain reaction in situ hybridization, rarely demonstrated the abrupt variation in keratohyaline granules and concomitan t perinuclear halos. The authors conclude that there is a wide spectrum of histologic changes in epidermodysplasia verruciformis and that viral testin g in conjunction with the histologic and clinical findings can differentiat e this premalignant entity from its mimics.