HPV Associated Dysplasia of the Oral Cavity: Understanding Your Pathology Report

Section Editor: Jason Wasserman MD PhD FRCPC
July 24, 2026

HPV-associated dysplasia of the oral cavity is a precancerous change in the lining of the mouth caused by infection with the human papillomavirus (HPV). Dysplasia means the cells lining the mouth have started to grow and behave abnormally. It is not cancer, but over time, and without treatment, it can develop into a type of mouth cancer called squamous cell carcinoma.

Receiving this diagnosis means an abnormal area was found in your mouth, a biopsy was taken, and the pathologist identified precancerous changes driven by HPV. This is a finding that needs treatment, but it is not cancer, and when changes like these are found and treated before they progress, the outcome is generally very good.

This article explains the findings you are likely to see on a pathology report for HPV-associated dysplasia of the oral cavity, what each one means, and why it matters for your care.

What causes HPV-associated dysplasia of the oral cavity?

HPV-associated dysplasia of the oral cavity is caused by infection with the human papillomavirus. HPV is a very common virus that infects squamous cells, the flat cells that line the mouth, throat, and other surfaces of the body. There are more than 100 types of HPV. Most cause no lasting harm and are cleared by the immune system on their own. A small number of high-risk types, especially HPV 16, can stay in the cells and interfere with the way cell growth is normally controlled.

High-risk HPV produces proteins that switch off the cell’s tumor suppressor genes, which normally act as brakes that stop cells from dividing when they should not. With those brakes disabled, the cells begin to grow abnormally, and over time this can lead to dysplasia and, eventually, cancer. This is the same process by which high-risk HPV causes precancerous changes in the oropharynx (the back of the mouth and throat), the cervix, and the anal canal.

HPV spreads through direct skin-to-skin contact, including sexual and oral-genital contact. It is one of the most widespread viruses in the world, and most sexually active adults will have at least one HPV infection in their lifetime. The large majority of these infections clear on their own without causing any lasting change. HPV-associated dysplasia develops only in the small number of people who have a lasting infection with a high-risk type.

What are the symptoms of HPV-associated dysplasia of the oral cavity?

Many people with HPV-associated dysplasia of the oral cavity, a precancerous change in the lining of the mouth, have no symptoms, especially early on. The condition is often found during a routine dental or medical checkup before it causes any problem. When symptoms are present, they may include:

A red, white, or mixed red-and-white patch in the mouth that does not go away
A slightly raised or thickened area on the tongue, floor of the mouth, or inner cheek
Mild pain, tenderness, or a burning sensation in the area
Difficulty swallowing, if the area is large or in an awkward location

Any patch or sore in the mouth that has not healed within two to three weeks should be examined by a dentist or doctor.

How is the diagnosis made?

The diagnosis is made when a pathologist examines a sample of the abnormal area under the microscope. The sample is obtained by biopsy, a small procedure in which a piece of tissue is removed and sent to the pathology laboratory. Under the microscope, the pathologist looks for abnormal squamous cells in the surface lining of the mouth and confirms that the abnormal cells have not grown down into the deeper tissue. That downward growth is called invasion, and its absence is what separates dysplasia from an invasive cancer.

In most cases, additional testing is performed to confirm that the dysplasia is caused by HPV rather than by something else such as tobacco. The two tests you are most likely to see on your report are:

p16 immunohistochemistry. This test detects a protein called p16, which builds up in large amounts in cells infected with high-risk HPV. A strong, widespread p16 result supports the diagnosis. This is explained further below.
In situ hybridization or PCR. These molecular tests detect the virus itself within the tissue and can confirm HPV and identify the specific type.

Your report may also describe the dysplasia as nonkeratinizing. This means the abnormal cells are not producing keratin, a tough surface protein. Under the microscope, this gives the cells a blue, basaloid look, and it is one of the features that helps the pathologist recognize HPV-associated dysplasia and tell it apart from other types of oral dysplasia.

Is HPV-associated dysplasia given a grade?

No. Unlike other forms of oral dysplasia, HPV-associated dysplasia of the oral cavity is usually not assigned a grade of mild, moderate, or severe. Research has shown that grading does not reliably predict cancer risk in HPV-associated lesions. If you are looking for a grade on your report and cannot find one, nothing has been left out. For this diagnosis, what matters is that the dysplasia is present and whether it has been completely removed, rather than a specific grade.

What does the p16 result mean?

p16 is a protein that normally acts as a brake on cell division. When high-risk HPV infects a cell, it disables this brake, and p16 builds up in large amounts throughout the cell. The pathologist detects this buildup using a test called immunohistochemistry.

A strong, widespread positive p16 result supports the diagnosis of HPV-associated dysplasia. If your report says the dysplasia is “p16 positive,” this confirms the HPV connection and is the expected result for this diagnosis. p16 is used here to help make the diagnosis. It is not a measure of how advanced the dysplasia is.

Surgical margins

The margin is the cut edge of the tissue removed during the procedure. Margin status matters for a precancerous condition because it shows whether all of the abnormal tissue was taken out.

Negative (clear) margin. No dysplasia at the cut edge. The abnormal area appears to have been completely removed, which is associated with a lower risk of progressing to cancer.
Positive margin. Dysplasia reaches the cut edge, meaning some abnormal tissue may remain. Your doctor will discuss whether more treatment is needed to remove it.
Cannot be assessed. The tissue was fragmented or the sample was small, so the edge cannot be evaluated reliably. In this situation, complete removal of any remaining abnormal area is usually recommended.

What is the risk that HPV-associated dysplasia will turn into cancer?

HPV-associated dysplasia of the oral cavity is a precancerous change in the lining of the mouth, and without treatment it carries a real risk of developing into squamous cell carcinoma over time. Studies to date suggest that roughly 10 to 15% of people with this diagnosis will go on to develop oral cavity cancer if the dysplasia is not completely removed.

Complete removal of the abnormal area is associated with a substantially lower risk of cancer and a better outcome, which is why removal with clear margins is the goal of treatment. It is also worth knowing that when HPV-associated cancers of the mouth and throat do develop, they tend to respond better to treatment than cancers not caused by HPV. Even so, this does not change the value of removing the dysplasia early, before a cancer has a chance to form.

What happens after the diagnosis?

The main treatment for HPV-associated dysplasia of the oral cavity is surgical removal of the abnormal area, with the goal of clear margins. This is usually done by an oral surgeon or a head and neck surgeon, and in most cases it is a minor procedure under local anesthesia.

After removal, follow-up is important, and the schedule depends on the margins, the size of the area, and your overall health and risk factors. In general, if the dysplasia was completely removed with clear margins, regular mouth examinations are still recommended, because new areas of dysplasia can develop over time in people with a lasting HPV infection. If margins were positive or the area was not fully removed, further treatment is usually recommended. If the dysplasia comes back or new areas appear, another biopsy and further treatment may be needed.

If you smoke or drink alcohol, stopping or cutting back is strongly recommended, because tobacco and alcohol are separate risk factors that can speed the progression of oral dysplasia to cancer.

Finally, it is worth knowing that the HPV vaccine is highly effective at preventing infection with the high-risk HPV types that cause dysplasia and cancer. The vaccine cannot treat an infection you already have, but it can protect people who have not yet been exposed. It works best when given before exposure to HPV, usually in adolescence, and is also recommended for adults up to age 26, with possible benefit for some adults up to age 45. This may be relevant for family members who have not been vaccinated.

Questions to ask your doctor

Was the abnormal area completely removed, and what did the margins show?
Do I need additional surgery or treatment?
How often should I come back for follow-up, and what will those visits involve?
What symptoms should prompt me to contact you before my next visit?
Would stopping smoking or reducing alcohol lower my risk?
Should my family members or partners be aware of anything related to this diagnosis?
Is HPV vaccination relevant for anyone in my household?