Verrucous Carcinoma
Comments:
Verrucous carcinoma is a low-grade variant of squamous cell carcinoma (SCC) of the oral cavity. It comprises 1% to 15% of all oral SCC, depending upon the local prevalence of smokeless tobacco or snuff usage. The most common sites within the oral cavity include mandibular vestibule, buccal mucosa, gingiva, tongue, and hard palate. The involved area frequently corresponds to the site of tobacco placement. Verrucous carcinoma can occur at various extraoral sites such as larynx, vulva/vagina, penis, anorectal, sinonasal, and esophagus. The typical patient is an elderly male (median age 65-70 years). The lesion is commonly present for 2-3 years before a definitive diagnosis is made. It appears as a painless, well-demarcated, thick plaque with papillary or verruciform excrescences. Depending upon the degree of keratinization and the host inflammatory response, the lesion may be white, pink, or erythematous. In long-standing cases, the underlying structures such as bone, cartilage, muscle, and salivary glands may be destroyed. If cervical lymph nodes are enlarged in verrucous carcinoma patients, they are usually due to inflammation rather than nodal metastasis. Case History: This photograph of left segmental mandibulectomy from a 67 year old male shows a 6 cm lesion with papillary excrescences on the alveolar ridge along with loss of two teeth. Biopsy confirmed verrucous carcinoma. Case courtesy of: Dr. Sanjay D. Deshmukh (Professor of Pathology) and Dr. Ninad J. Gadekar (Oncosurgeon), Dr. Vithalrao Vikhe Patil Foundation's Medical College & Hospitals, Ahmednagar, India.