Focal epithelial hyperplasias, also known as Heck's disease or focal epithelial hyperplasia (FEH), is a benign papillomatous condition that affects the oral mucosa. It is primarily caused by the human papillomavirus (HPV), specifically types 13 and 32.
This condition is typically characterized by the development of multiple small, soft, and painless papules or nodules on the oral mucosa. It usually appears in childhood and adolescence, with a higher prevalence in certain populations, such as Native Americans and Eskimos.
Focal epithelial hyperplasias often affect the buccal mucosa, tongue, or lips, and can vary in size from a few millimeters to a centimeter in diameter. These lesions have a characteristic pink or white color and may have a rough or wart-like appearance.
Histologically, focal epithelial hyperplasias are characterized by the proliferation of squamous epithelium, resulting in an increased number of epithelial cells. The epithelial cells may also display viral cytopathic changes, such as prominent koilocytes, which are enlarged and vacuolated cells containing viral particles.
Although focal epithelial hyperplasias are considered benign and usually asymptomatic, they may cause discomfort or aesthetic concerns due to their location or size. Treatment options include surgical excision, laser therapy, or cryotherapy, although many lesions do not require intervention and may resolve spontaneously over time.
Regular monitoring and follow-up are recommended to ensure proper management and to detect any potential malignant transformation, although malignant progression is very rare in focal epithelial hyperplasias.
