A 13-year-old Hispanic female patient was referred to our Unit by her Dermatologist for multiple and bilateral lesions on the buccal, labial and lingual mucosa. The lesions appeared in clusters and were soft, non-tender, flattened and of the same colour of the oral mucosa.
The patient was otherwise healthy and she did not present other skin lesions.
The clinical findings were consistent with the diagnosis of Heck’s disease. This disorder, also called focal epithelial hyperplasia, is a virus-induced, localised proliferation of oral squamous epithelium firstly described in native Americans and Inuits. The lesions, typically seen during childhood, are tough to be caused by papillomavirus type 13 and possibly 32. Spontaneous regression of focal epithelial hyperplasia has been reported after months or years and this spontaneous recovery is presumed to be the cause of the rarity of the disease in adults.
In this patient, a surgical removal of the lesions was planned for aesthetic purposes and because the patient reported frequent masticatory trauma of the lesions. The removal was completed in 3 sessions using the Quantum Molecular Resonance Scalpel (Vesalius®, Telea, Sandrigo, Italy). This device is based on a physic theory, the molecular resonance (RQM), which allows the operator to cut and coagulate tissues simultaneously in a precise and controlled way, without application of any manual pressure or burning. It uses electric current to produce a flux of quanta sufficient to break molecular bonds by resonance.
During the interventions no bleeding was recorded and sutures were not necessary.
The histopthological evaluation of the specimen showed considerable acanthosis and superficial keratinocytes with the typical koilocytic changes of papillomavirus infection.
The post-operative period was uneventful and the mucosa healed without scars.
References
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