A patient presents with a cauliflower-shaped, painless lesion on the tip of the tongue. He wants it removed. What is the MOST likely diagnosis and treatment?

Correct answer: D. HPV-related squamous papilloma — excision

• A. Incorrect. Granular cell tumors appear as smooth, firm, yellowish nodules — not cauliflower-shaped.
• B. Incorrect. Traumatic ulcers are shallow ulcerations with an erythematous halo, not proliferative papillary masses.
• C. Incorrect. A fibroma is smooth, dome-shaped, and pink — not cauliflower-shaped.
• D. Correct. A cauliflower-shaped (papillary/verrucous), painless lesion on the tongue tip is characteristic of an HPV-related squamous papilloma. These have a warty, exophytic appearance and are asymptomatic. Treatment is excision.