Oral mucosal lesions with a papillary or verrucous surface are a heterogenous group of conditions with widely varying clinical behaviour. The etiology is variable and includes infective, traumatic or neoplastic processes. The majority of these lesions are precanceous lesion. Therefore, a biopsy is required to establish a diagnosis and the microscopic examination must be coordinated with the clinical findings. This paper reviews the clinical features and significance of papillary or verrucous lesions.