Inverted Papilloma: Understanding Precancerous Nasal Growths
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: Key Facts About Inverted Papilloma
An inverted papilloma is a precancerous growth in the lining of the nasal cavity or sinuses in which cells grow inward into the underlying tissue. About 5 to 10 out of 100 transform into squamous cell carcinoma. The common symptom is one-sided nasal congestion. Imaging and endoscopic biopsy confirm it, and treatment is endoscopic surgical removal with regular checkups.
Feature | Details |
Nature | A precancerous growth in the lining of the nasal cavity or paranasal sinuses. [1] |
Unique trait | Nests of cells grow inward ("invert") into the underlying tissue. [1] |
Cancer risk | 5 to 10 out of 100 transform into sinonasal squamous cell carcinoma. [1] |
Common symptom | Nasal congestion, usually on only one side. [1] |
Diagnosis | CT or MRI imaging, and a nasal endoscopy with biopsy to confirm. [1] |
Main treatment | Surgical removal, usually through the nostrils with an endoscope, followed by regular checkups. [1] |
What the research says
HPV is linked to malignant transformation. A meta-analysis of 19 studies found a strong association between HPV in an inverted papilloma and progression to squamous cell carcinoma (pooled odds ratio 2.38; weighted odds ratio 2.80). The authors note that HPV testing is not currently standard of care and that more study is needed. (Stepp et al., Int Forum Allergy Rhinol, 2021)
HPV may also be linked to recurrence, but the data are mixed. A meta-analysis of 25 studies covering 1,116 benign sinonasal inverted papillomas found a pooled odds ratio of 2.05 for recurrence in HPV-positive tumors. The result was not significant when low-risk and high-risk HPV subtypes were analyzed separately, and findings varied among recent studies. (Alqudrah et al., Otolaryngol Head Neck Surg, 2025)
Better endoscopic tools have reduced recurrence, but difficult cases remain. A review describes inverted papilloma as the most common sinonasal tumor, with a tendency for recurrence and a risk of malignant degeneration. It reports that the overall recurrence rate has decreased with high-definition endoscopic optics and advanced surgical tools, while multiply recurrent tumors and those involving vital neurovascular structures remain challenging. (Eide et al., Cancers (Basel), 2022)
What Is an Inverted Papilloma?
An inverted papilloma is a precancerous growth that forms in the membrane lining your nasal cavity or paranasal sinuses. It gets its name from the way the cells look under a microscope: nests of epithelial cells "invert," or grow inward. These growths are also known as sinonasal inverted papillomas. [1]
They are "locally invasive." This means they can grow into important structures in your face, like bone, the eye socket, nerves and blood vessels. They can grow back after surgery, and in some cases they become cancerous: anywhere from 5 to 10 out of 100 transform into cancer called sinonasal squamous cell carcinoma. This is why you will need surgery to remove an inverted papilloma, and long-term follow-up care so you can get treatment if it grows back. [1]
Recognizing the Symptoms and Signs
Small papillomas may not cause symptoms, or they can cause symptoms that are similar to other common conditions, like a sinus infection. Signs include: [1]
Facial pain or pressure.
A weakened sense of smell.
Headaches.
Nasal congestion, usually on only one side.
Postnasal drip.
A runny nose.
Usually, symptoms are on just one side of your face, where the papilloma is, but sometimes you feel the effects on both sides. If symptoms last despite standard allergy or sinus treatment, an ear, nose and throat (ENT) specialist can check whether a growth is the cause. [1]
Causes and Risk Factors
Medical experts do not know the cause of inverted papillomas, but there are possible connections with: [1]
HPV infections.
Epstein-Barr virus (EBV) infections.
Chronic inflammation.
Smoking.
Exposure to workplace pollutants like welding fumes, nickel compounds and certain types of solvents.
Males are two to three times more likely to have them than females, and most people diagnosed are in their 40s or 50s. Some studies show that papillomas that contain high-risk strains of HPV are more likely to transform into cancer. [1]
Diagnosis and Surgical Treatment
Sometimes healthcare providers discover an inverted papilloma while checking on a different issue, or while trying to figure out what is causing nasal symptoms. You will likely need to see an ear, nose and throat (ENT) doctor, who may order a CT scan or MRI so they can see the growth inside your nose or sinuses. A nasal endoscopy with a biopsy is the only way to know for sure that you have an inverted papilloma. This procedure uses a rigid telescope with a camera to see inside your nasal cavity and sinuses, and surgeons can sometimes remove a small portion of the growth in the office for lab testing. [1]
Treatment is surgery to remove the inverted papilloma: [1]
Endoscopic surgery: Usually your provider can do minimally invasive surgery that does not involve cuts to your face, using the same kind of rigid telescope and special instruments to remove the growth through your nostrils.
Open surgery: In very rare cases, you may need open surgery if the entire tumor cannot be removed with the scope.
Radiation therapy: If you are not a candidate for surgery, your provider may use radiation therapy to destroy an inverted papilloma.
Long-Term Monitoring and Outlook
Inverted papillomas do not go away on their own, and because there is a chance they could transform into cancer, it is important to have surgery to remove them as soon as possible. After surgery, you will see your healthcare provider regularly to check whether the papilloma comes back. Research shows that most that grow back do so within the first two years, but sometimes they grow back 10 to 15 years later. Your provider will suggest a checkup schedule to detect any growths as soon as possible so there are no treatment delays. [1]
If one does grow back, it may return as another papilloma, or sometimes as cancer. Either way, you will need surgery again. With cancer, you will likely get radiation therapy afterward to reduce the likelihood that it returns. The five-year survival rate for a cancerous inverted papilloma following surgery and radiation is 84%, which means treatment often gets rid of the cancer. [1]
Nasal Polyp vs. Inverted Papilloma
Nasal polyps form because of inflammation in your nasal cavity or sinuses. This is different from inverted papillomas, where growth seems related to many potential causes, including HPV. While you may need surgery to remove a nasal polyp, there is no risk of it transforming into cancer. [1]
Learn more. For more evidence-based health guides, visit Rinnit.com.
Frequently Asked Questions
What is the difference between a nasal polyp and an inverted papilloma?
Nasal polyps form because of inflammation in the nasal cavity or sinuses, and there is no risk of one turning into cancer. An inverted papilloma is a precancerous growth that can invade nearby structures, can grow back after surgery, and in some cases becomes cancerous.
Do inverted papillomas go away on their own?
No. They do not go away on their own, and because there is a chance they could transform into cancer, treatment is surgical removal as soon as possible.
Why is it called "inverted"?
The name comes from the way nests of epithelial cells look under a microscope, where they "invert," or grow inward into the underlying tissue.
Is the surgery painful?
Often the surgeon can use a rigid telescope and special instruments to remove the growth through your nostrils, without cuts to your face. Ask your surgeon what recovery will feel like for your situation.
How often will I need follow-up appointments?
Your provider will suggest a checkup schedule to detect any new growth as soon as possible. Most growths that return do so within the first two years, but sometimes they return 10 to 15 years later.
Can HPV cause an inverted papilloma?
Medical experts do not know the cause, but there are possible connections with HPV and Epstein-Barr virus (EBV) infections. Some studies show that papillomas containing high-risk HPV strains are more likely to transform into cancer.
What happens if I do not have surgery?
The growth can keep expanding and grow into important structures in your face, such as bone, the eye socket, nerves and blood vessels, and it may become cancerous.
Can it affect both sides of the nose?
Symptoms are usually on just one side of the face, where the papilloma is, but sometimes you feel the effects on both sides.
Is smoking linked to inverted papilloma?
Smoking is one of the possible connections listed with the development of inverted papilloma, along with chronic inflammation, HPV and EBV infections, and workplace pollutants.
What is the survival rate if it becomes cancer?
The five-year survival rate for a cancerous inverted papilloma following surgery and radiation is 84%.
What does "locally invasive" mean?
The term "locally invasive" means the growth can grow into important nearby structures in your face, such as bone, the eye socket, nerves and blood vessels.
Is a biopsy always necessary?
A nasal endoscopy with a biopsy is the only way to know for sure that you have an inverted papilloma.
Can inverted papillomas be prevented?
The cause is unknown, so there is no proven way to prevent them. Smoking and exposure to workplace pollutants such as welding fumes, nickel compounds and certain solvents are among the possible connections.
Who is most likely to get one?
Males are two to three times more likely to have an inverted papilloma than females, and most people diagnosed are in their 40s or 50s.
Is radiation ever used?
Radiation therapy may be used to destroy an inverted papilloma if you are not a candidate for surgery, and it is usually given after surgery when the growth has become cancer.
Conclusion
An inverted papilloma is not cancer, but for reasons medical experts do not fully understand, it can transform into cancer and can grow into bones, nerves and blood vessels in your nasal cavity. That is why surgical removal is needed. With close monitoring, your healthcare provider can treat any relapse right away to protect your nose and sinuses. [1]
References
Cleveland Clinic. Inverted Papilloma. Cleveland Clinic. Last updated February 17, 2026. https://my.clevelandclinic.org/health/diseases/inverted-papilloma
Stepp WH, Farzal Z, Kimple AJ, et al. HPV in the malignant transformation of sinonasal inverted papillomas: A meta-analysis. Int Forum Allergy Rhinol. 2021;11(10):1461-1471. PMID 33956402. https://doi.org/10.1002/alr.22810
Alqudrah F, Kota S, Morgan J, et al. Human Papilloma Virus Infection and Sinonasal Inverted Papilloma Recurrence: A Meta-Analysis. Otolaryngol Head Neck Surg. 2025;172(4):1155-1163. PMID 39739414. https://doi.org/10.1002/ohn.1108
Eide JG, Welch KC, Adappa ND, et al. Sinonasal Inverted Papilloma and Squamous Cell Carcinoma: Contemporary Management and Patient Outcomes. Cancers (Basel). 2022;14(9):2195. PMID 35565324. https://doi.org/10.3390/cancers14092195
Medical disclaimer
This article is for general educational purposes only and is not a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider with any questions about a medical condition or surgery.
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