A papillary lesion is found on the tongue of a patient who smokes 2 packs of cigarettes per day and reports that the lesion has been growing progressively for 2 months. Histopathology reveals koilocytes. How would the lesion's surface morphology be BEST described?

Correct answer: C. Papillary (finger-like projections)

• A. Ulcerative lesions have surface breakdown with tissue loss (ulcer). HPV lesions are typically exophytic and papillary, not ulcerated — unless traumatically injured.
• B. Flat/macular lesions (e.g., melanosis, amalgam tattoo) have no surface elevation or projection — opposite of the papillary morphology described.
• C. CORRECT. A papillary lesion has finger-like or wart-like projections extending from the surface — this is the defining morphological feature of HPV-related oral lesions (verruca vulgaris, condyloma, papilloma, squamous papilloma). The presence of koilocytes (HPV-infected squamous cells with perinuclear halos) confirms viral etiology. Papillary = warty/verrucous surface.
• D. Vesicular lesions (fluid-filled blisters) are characteristic of herpes, pemphigus, or burns — not HPV papillomas.