A 35-year-old professional businesswoman notices the appearance of several hyperkeratotic, well-demarcated growths on the palm side of her index finger and on her toe. They do not change in size and cause her only minimal discomfort. Biopsy of one of the lesions is shown at 40x. Which of the following viruses is the most likely etiologic agent?H&E strain (40x) of skin biopsy

The vignette describes common warts caused by HPV (b) and the accompanying image shows koilocytes in hyperplastic skin, which are pathognomonic for HPV infection. HPVs cause non-genital cutaneous and anogenital or mucosal syndromes. Non-genital cutaneous syndromes include common warts, flat warts, plantar warts, and epidermodysplasia verruciformis. The HPV types associated with these lesions are different from the types that cause mucosal syndromes (6, 11, 16, 18, 31, and 45) except for type 2 that can cause common warts, plantar warts, and oral papillomas. Adenovirus (a) does not cause skin lesions; Molluscipox virus (c) causes pearly lesions with dimpled centers from which white material can be extruded. When it causes skin lesions, echovirus (d) is associated with a maculopapular rash. VZV (e) causes vesicular lesions.