Treatment of Oral Skin Tags (Oral Squamous Papillomas)
Simple excision with scissors or scalpel under local anesthesia is the definitive treatment for oral skin tags, which are benign HPV-related lesions (oral squamous papillomas) that require removal for diagnosis confirmation and symptom relief. 1
Understanding the Lesion
Oral "skin tags" are most commonly oral squamous papillomas—benign, HPV-associated growths that appear as sessile or pedunculated lesions with papillary projections in the mouth. 1 These differ from cutaneous skin tags (acrochordons) and are typically caused by low-risk HPV genotypes, particularly HPV 6 and 11. 1
Other benign oral lesions that may resemble skin tags include:
- Verruca vulgaris (HPV 2 and 4): Well-circumscribed growths with white pebbly surface, more common in children via autoinoculation from fingers to mouth 1
- Condyloma acuminatum (HPV 6 and 11): Sessile or pedunculated with papillary projections, more common in adolescents and young adults 1
Definitive Treatment Approach
Surgical Excision (First-Line)
Perform simple excision with scissors or scalpel under local anesthesia for all oral papillomas to achieve complete removal and allow histopathologic confirmation. 1 This is the standard approach because:
- Complete removal prevents recurrence 1
- Histopathologic examination confirms the diagnosis and rules out dysplasia 1
- Low-risk HPV lesions like oral papillomas can harbor high-risk genotypes (HPV 16,18) requiring pathologic assessment 1
Alternative Surgical Methods
For patients where simple excision is challenging:
- CO2 laser ablation can be used for lesions in difficult anatomical locations 1
- Electrocauterization is an option but may cause more tissue damage 1
- Cryosurgery can be considered for smaller lesions 1
Post-Excision Care
Immediate Wound Management
- Apply white soft paraffin ointment to the excision site every 2 hours to protect the wound and promote healing 2, 3
- Clean the mouth daily with warm saline mouthwashes to reduce bacterial contamination 2, 3
- Use benzydamine hydrochloride rinse or spray every 2-4 hours, particularly before eating, for pain control 2, 3
Pain Management
- Prescribe oral analgesics (paracetamol/acetaminophen) to be taken 20 minutes prior to eating if discomfort is significant 2
- Consider topical anesthetic preparations (viscous lidocaine 2%) for inadequate pain control 2
Critical Pitfalls to Avoid
- Never assume all oral growths are benign—always obtain histopathologic confirmation, as condylomata can show low-grade dysplasia that may progress to high-grade dysplasia or carcinoma, particularly if infected with high-risk HPV genotypes 1
- Do not use alcohol-containing mouthwashes post-excision as they cause additional pain and irritation 2, 4
- Avoid incomplete excision as this leads to recurrence 1
- Do not chronically use petroleum-based products on oral mucosa as they promote dehydration and increase secondary infection risk 2, 4
When Histopathology Shows Concerning Features
If pathology reveals:
- High-grade dysplasia or carcinoma: Urgent referral to oral surgery or head and neck surgery for wider excision and staging 1
- High-risk HPV genotypes (16,18): Close follow-up and consideration of wider margins 1
- Recurrent lesions: Re-excision with wider margins and consideration of alternative ablative techniques 1