Cowden's disease (multiple hamartoma syndrome).

Cutaneous and oral lesions appearing as verrucous papules are a regular and diagnostic finding in Cowden's disease. The lesion occur predominantly over the central portion of the face, concentrated around orifices, lips, gingiva, and tongue, and over the acral portions of the upper extremities. These skin lesions have been found to be associated with fibrocystic breast disease, carcinoma of the breast, thyroid tumors, ovarian cysts, gastrointestinal polyposis, fibromas, angiomas, and lipomas. It is important to be able to distinguish the skin lesions from simple verruca vulgaris because they serve as a cutaneous marker for existing or potential internal malignancy, especially of the breast and thyroid.