Verrucous carcinoma

See also: List of verrucous carcinoma subtypes

Verrucous carcinoma

Verrucous carcinoma on the penis

Verrucous carcinoma (VC) is an uncommon variant of squamous cell carcinoma.[1] This form of cancer is often seen in those who chew tobacco or use snuff orally, so much so that it is sometimes referred to as "Snuff dipper's cancer".

## Contents

* 1 Signs and symptoms
* 2 Cause
* 3 Risk factors
* 4 Locations
* 5 Diagnosis
* 5.1 Subtypes
* 6 Treatment
* 7 Prognosis
* 8 See also
* 9 References
* 10 Further reading
* 11 External links

## Signs and symptoms[edit | edit source]

Carcinoma cuniculatum, subtype

* Age - usually over 60 years old
* Sex - males are more prone
* Site - gingiva, buccal mucosa, alveolar mucosa, hard palate, floor of the mouth, larynx, oesophagus, penis, vagina, scrotum.
* Clinical presentation:
* It is a slow growing, diffuse, exophytic lesion usually covered by leukoplakic patches.
* Invasive lesions quickly invade bones.
* It can rapidly become fixed with underlying periosteum and cause gradual destruction of jaw bone.
* Enlarged regional lymph nodes.
* Lesion shows painful multiple rugae-like folds and deep clefts between them.
* Regional lymph nodes tender and enlarged.
* Pain and difficulty in mastication.

## Cause[edit | edit source]

This form of cancer is often seen in those who chew tobacco or use snuff orally, so much so that it is sometimes referred to as "Snuff dipper's cancer". Chewing betel nuts is an additional risk factor commonly seen in Taiwan.

## Risk factors[edit | edit source]

The major risk factors are cigarette smoking and alcohol consumption, while betel nut is an additional factor in Taiwan. Different gene mutation sites in head and neck cancer between western countries and Taiwan have been reported.[2][3][4][5] The presentation of VC originated from exposure to different carcinogens may not be the same.

## Locations[edit | edit source]

Verrucous carcinoma may occur in various head and neck locations, as well as in the genitalia or sole of the foot. The oral cavity is the most common site of this tumor.[6] The ages range from 50 to 80 years with a male predominance and a median age of 67 years.[7] VC may grow large in size, resulting in the destruction of adjacent tissue, such as bone and cartilage.[8]

## Diagnosis[edit | edit source]

Surgeons must provide adequate specimens including the full thickness of the tumors and adjacent uninvolved mucosa for correct histopathology diagnosis.[9]

* Low-magnification micrograph of penile verrucous carcinoma. The tumor is characterized by prominent papillomatosis.[10]

* High magnification. There is prominent acanthosis. The tumor front is broad-based and pushes the subepithelial tissues.[10]

### Subtypes[edit | edit source]

Epithelioma cuniculatum (also known as Carcinoma cuniculatum,[11]: 654 and Ackerman tumor[12]) is a subtype of verrucous carcinoma,[13] characterized by well-differentiated epithelial cells which lack cytological atypia, but display a blunt papillary/pebbly surface and keratin-filled crypts extending deep into the connective tissue.[14] These keratin-filled resemble rabbit burrows.[14] It is located almost exclusively on the foot,[13] but at least oral location has also been described.[14]

## Treatment[edit | edit source]

Surgery is considered the treatment of choice, but the extent of surgical margin and the adjuvant radiotherapy are still controversial.

Surgical excision alone is effective for controlling VC, but elective neck dissection is not necessary even in patients in the advanced stages.[15]

## Prognosis[edit | edit source]

Most patients with verrucous carcinoma have a good prognosis. Local recurrence is not uncommon, but metastasis to distant parts of the body is rare. Patients with oral verrucous carcinoma may be at greater risk of a second oral squamous cell carcinoma, for which the prognosis is worse.

## See also[edit | edit source]

* List of cutaneous conditions
* List of verrucous carcinoma subtypes

## References[edit | edit source]

1. ↑ Ridge JA, Glisson BS, Lango MN, et al. "Head and Neck Tumors" Archived 2009-07-20 at the Wayback Machine in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach Archived 2013-10-04 at the Wayback Machine. 11 ed. 2008.
2. ↑ Xu J, Gimernez-Conti IB, Cunningham JE, Collet AM, Luna MA, Lanfranchi HE, Spitz MR, Conti CJ. Alterations of p53, cyclin D1, Rb, and H-ras in human oral carcinoma related to tobacco use. Cancer 1998;83:204-12
3. ↑ Saranath D, Chang SE, Bhotie LT, Panchal RG, Kerr IB, Mehta AR, Johnson NW, Deo MG. High frequency mutation in codons 12 and 61 of H-ras oncogene in chewing tobacco-related human oral carcinoma in India. Br J Cancer 1991;63:573-78
4. ↑ Yeudall WA, Torrance LK, Elsegood KA, Speight P, Soully C, Prime SS. Ras gene point mutations rare event in premalignant tissues and malignant cells and tissues from oral mucosa lesions. Eur J Cancer 1993;29B:63-7
5. ↑ Kuo MYP, Jeng JH, Chiang CP, Hahn LJ. Mutations of kiras oncogened codon 12 in betel nut chewing related human oral squamous cell carcinoma in Taiwan. J Oral Pathol Med 1994;23:70-4.
6. ↑ Medina JE, Dichtel W, Luna MA. Verrucous-squamous carcinoma of the oral cavity: a clinicopathologic study of 104 cases. Arch Otolaryngol 1984;110:437-40
7. ↑ Tornes K, Bang G, Koppang HS, Pedweson KN. Oral verrucous carcinoma. Int J Oral Surg 1985;14:485-92
8. ↑ Koch BB, Trask DK, Hoffman HT, Karnell LH, Robinson RA, Zhen W, Menck HR. National survey of head and neck verrucous carcinoma. Cancer 2001;92:110-20
9. ↑ McDonald JS, Crissman JD, Gluckman JL. Verrucous Carcinoma of the oral cavity. Head Neck Surg 1982;5:22-8
10. ↑ 10.0 10.1 Philippou, Prodromos; Kitsios, Christos; Miliatou, Maria; Poullou, Christiana; Konstantinou, Pavlos (2019). "Organ-Sparing Surgery for a Giant Verrucous Carcinoma of the Penile Shaft: A Case Report and Review of the Literature". Case Reports in Urology. 2019: 1537379. doi:10.1155/2019/1537379. ISSN 2090-696X. PMC 6408996. PMID 30918740.
\- "This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited."
11. ↑ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
12. ↑ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
13. ↑ 13.0 13.1 Suen, K.; Wijeratne, S.; Patrikios, J. (2012). "An unusual case of bilateral verrucous carcinoma of the foot (epithelioma cuniculatum)". Journal of Surgical Case Reports. 2012 (12): rjs020. doi:10.1093/jscr/rjs020. ISSN 2042-8812. PMC 3855215. PMID 24968418.
14. ↑ 14.0 14.1 14.2 Datar, Uma Vasant (2017). "Oral Carcinoma Cuniculatum: A New Entity in the Clinicopathological Spectrum of Oral Squamous Cell Carcinoma". Journal of Clinical and Diagnostic Research. 11 (1): ZD37–ZD39. doi:10.7860/JCDR/2017/23437.9226. ISSN 2249-782X. PMC 5324519. PMID 28274074.
15. ↑ Chang Gung Med J 2003;26:807-12

## Further reading[edit | edit source]

* Surgical Treatment of Oral Verrucous Carcinoma by Chung-Jan Kang, MD; Joseph Tung-Chieh Chang1, MD; Tsung-Ming Chen, MD; I-How Chen, MD; Chun-Ta Liao, MD

## External links[edit | edit source]

* eMedicine.com article Archived 2008-12-04 at the Wayback Machine

Classification|

* ICD-O: M8051/3
* MeSH: D018289

|

External resources|

* eMedicine: derm/452

* v
* t
* e

Glandular and epithelial cancer

Epithelium|

| Papilloma/carcinoma|

* Small-cell carcinoma
* Combined small-cell carcinoma
* Verrucous carcinoma
* Squamous cell carcinoma
* Basal-cell carcinoma
* Transitional cell carcinoma
* Inverted papilloma

|

Complex epithelial|

* Warthin's tumor
* Thymoma
* Bartholin gland carcinoma

Glands|

| Adenomas/
adenocarcinomas|

| Gastrointestinal|

* tract: Linitis plastica
* Familial adenomatous polyposis

* pancreas
* Insulinoma
* Glucagonoma
* Gastrinoma
* VIPoma
* Somatostatinoma

* Cholangiocarcinoma
* Klatskin tumor
* Hepatocellular adenoma/Hepatocellular carcinoma

|

Urogenital|

* Renal cell carcinoma
* Endometrioid tumor
* Renal oncocytoma

Endocrine|

* Prolactinoma
* Multiple endocrine neoplasia
* Adrenocortical adenoma/Adrenocortical carcinoma
* Hürthle cell

Other/multiple|

* Neuroendocrine tumor
* Carcinoid
* Adenoid cystic carcinoma
* Oncocytoma
* Clear-cell adenocarcinoma
* Apudoma
* Cylindroma
* Papillary hidradenoma

Adnexal and
skin appendage|

* sweat gland
* Hidrocystoma
* Syringoma
* Syringocystadenoma papilliferum

Cystic, mucinous,
and serous|

| Cystic general|

* Cystadenoma/Cystadenocarcinoma

|

Mucinous|

* Signet ring cell carcinoma
* Krukenberg tumor
* Mucinous cystadenoma / Mucinous cystadenocarcinoma
* Pseudomyxoma peritonei
* Mucoepidermoid carcinoma

Serous|

* Ovarian serous cystadenoma / Pancreatic serous cystadenoma / Serous cystadenocarcinoma / Papillary serous cystadenocarcinoma

Ductal, lobular,
and medullary|

| Ductal carcinoma|

* Mammary ductal carcinoma
* Pancreatic ductal carcinoma
* Comedocarcinoma
* Paget's disease of the breast / Extramammary Paget's disease

|

Lobular carcinoma|

* Lobular carcinoma in situ
* Invasive lobular carcinoma

Medullary carcinoma|

* Medullary carcinoma of the breast
* Medullary thyroid cancer

Acinar cell|

* Acinic cell carcinoma

* v
* t
* e

Oral and maxillofacial pathology

Lips

* Cheilitis
* Actinic
* Angular
* Plasma cell
* Cleft lip
* Congenital lip pit
* Eclabium
* Herpes labialis
* Macrocheilia
* Microcheilia
* Nasolabial cyst
* Sun poisoning
* Trumpeter's wart

Tongue

* Ankyloglossia
* Black hairy tongue
* Caviar tongue
* Crenated tongue
* Cunnilingus tongue
* Fissured tongue
* Foliate papillitis
* Glossitis
* Geographic tongue
* Median rhomboid glossitis
* Transient lingual papillitis
* Glossoptosis
* Hypoglossia
* Lingual thyroid
* Macroglossia
* Microglossia
* Rhabdomyoma

Palate

* Bednar's aphthae
* Cleft palate
* High-arched palate
* Palatal cysts of the newborn
* Inflammatory papillary hyperplasia
* Stomatitis nicotina
* Torus palatinus

Oral mucosa – Lining of mouth

* Amalgam tattoo
* Angina bullosa haemorrhagica
* Behçet's disease
* Bohn's nodules
* Burning mouth syndrome
* Candidiasis
* Condyloma acuminatum
* Darier's disease
* Epulis fissuratum
* Erythema multiforme
* Erythroplakia
* Fibroma
* Giant-cell
* Focal epithelial hyperplasia
* Fordyce spots
* Hairy leukoplakia
* Hand, foot and mouth disease
* Hereditary benign intraepithelial dyskeratosis
* Herpangina
* Herpes zoster
* Intraoral dental sinus
* Leukoedema
* Leukoplakia
* Lichen planus
* Linea alba
* Lupus erythematosus
* Melanocytic nevus
* Melanocytic oral lesion
* Molluscum contagiosum
* Morsicatio buccarum
* Oral cancer
* Benign: Squamous cell papilloma
* Keratoacanthoma
* Malignant: Adenosquamous carcinoma
* Basaloid squamous carcinoma
* Mucosal melanoma
* Spindle cell carcinoma
* Squamous cell carcinoma
* Verrucous carcinoma
* Oral florid papillomatosis
* Oral melanosis
* Smoker's melanosis
* Pemphigoid
* Benign mucous membrane
* Pemphigus
* Plasmoacanthoma
* Stomatitis
* Aphthous
* Denture-related
* Herpetic
* Smokeless tobacco keratosis
* Submucous fibrosis
* Ulceration
* Riga–Fede disease
* Verruca vulgaris
* Verruciform xanthoma
* White sponge nevus

Teeth (pulp, dentin, enamel)

* Amelogenesis imperfecta
* Ankylosis
* Anodontia
* Caries
* Early childhood caries
* Concrescence
* Failure of eruption of teeth
* Dens evaginatus
* Talon cusp
* Dentin dysplasia
* Dentin hypersensitivity
* Dentinogenesis imperfecta
* Dilaceration
* Discoloration
* Ectopic enamel
* Enamel hypocalcification
* Enamel hypoplasia
* Turner's hypoplasia
* Enamel pearl
* Fluorosis
* Fusion
* Gemination
* Hyperdontia
* Hypodontia
* Maxillary lateral incisor agenesis
* Impaction
* Wisdom tooth impaction
* Macrodontia
* Meth mouth
* Microdontia
* Odontogenic tumors
* Keratocystic odontogenic tumour
* Odontoma
* Dens in dente
* Open contact
* Premature eruption
* Neonatal teeth
* Pulp calcification
* Pulp stone
* Pulp canal obliteration
* Pulp necrosis
* Pulp polyp
* Pulpitis
* Regional odontodysplasia
* Resorption
* Shovel-shaped incisors
* Supernumerary root
* Taurodontism
* Trauma
* Avulsion
* Cracked tooth syndrome
* Vertical root fracture
* Occlusal
* Tooth loss
* Edentulism
* Tooth wear
* Abrasion
* Abfraction
* Acid erosion
* Attrition

Periodontium (gingiva, periodontal ligament, cementum, alveolus) – Gums and tooth-supporting structures

* Cementicle
* Cementoblastoma
* Gigantiform
* Cementoma
* Eruption cyst
* Epulis
* Pyogenic granuloma
* Congenital epulis
* Gingival enlargement
* Gingival cyst of the adult
* Gingival cyst of the newborn
* Gingivitis
* Desquamative
* Granulomatous
* Plasma cell
* Hereditary gingival fibromatosis
* Hypercementosis
* Hypocementosis
* Linear gingival erythema
* Necrotizing periodontal diseases
* Acute necrotizing ulcerative gingivitis
* Pericoronitis
* Peri-implantitis
* Periodontal abscess
* Periodontal trauma
* Periodontitis
* Aggressive
* As a manifestation of systemic disease
* Chronic
* Perio-endo lesion
* Teething

Periapical, mandibular and maxillary hard tissues – Bones of jaws

* Agnathia
* Alveolar osteitis
* Buccal exostosis
* Cherubism
* Idiopathic osteosclerosis
* Mandibular fracture
* Microgenia
* Micrognathia
* Intraosseous cysts
* Odontogenic: periapical
* Dentigerous
* Buccal bifurcation
* Lateral periodontal
* Globulomaxillary
* Calcifying odontogenic
* Glandular odontogenic
* Non-odontogenic: Nasopalatine duct
* Median mandibular
* Median palatal
* Traumatic bone
* Osteoma
* Osteomyelitis
* Osteonecrosis
* Bisphosphonate-associated
* Neuralgia-inducing cavitational osteonecrosis
* Osteoradionecrosis
* Osteoporotic bone marrow defect
* Paget's disease of bone
* Periapical abscess
* Phoenix abscess
* Periapical periodontitis
* Stafne defect
* Torus mandibularis

Temporomandibular joints, muscles of mastication and malocclusions – Jaw joints, chewing muscles and bite abnormalities

* Bruxism
* Condylar resorption
* Mandibular dislocation
* Malocclusion
* Crossbite
* Open bite
* Overbite
* Overeruption
* Overjet
* Prognathia
* Retrognathia
* Scissor bite
* Maxillary hypoplasia
* Temporomandibular joint dysfunction

Salivary glands

* Benign lymphoepithelial lesion
* Ectopic salivary gland tissue
* Frey's syndrome
* HIV salivary gland disease
* Necrotizing sialometaplasia
* Mucocele
* Ranula
* Pneumoparotitis
* Salivary duct stricture
* Salivary gland aplasia
* Salivary gland atresia
* Salivary gland diverticulum
* Salivary gland fistula
* Salivary gland hyperplasia
* Salivary gland hypoplasia
* Salivary gland neoplasms
* Benign: Basal cell adenoma
* Canalicular adenoma
* Ductal papilloma
* Monomorphic adenoma
* Myoepithelioma
* Oncocytoma
* Papillary cystadenoma lymphomatosum
* Pleomorphic adenoma
* Sebaceous adenoma
* Malignant: Acinic cell carcinoma
* Adenocarcinoma
* Adenoid cystic carcinoma
* Carcinoma ex pleomorphic adenoma
* Lymphoma
* Mucoepidermoid carcinoma
* Sclerosing polycystic adenosis
* Sialadenitis
* Parotitis
* Chronic sclerosing sialadenitis
* Sialectasis
* Sialocele
* Sialodochitis
* Sialosis
* Sialolithiasis
* Sjögren's syndrome

Orofacial soft tissues – Soft tissues around the mouth

* Actinomycosis
* Angioedema
* Basal cell carcinoma
* Cutaneous sinus of dental origin
* Cystic hygroma
* Gnathophyma
* Ludwig's angina
* Macrostomia
* Melkersson–Rosenthal syndrome
* Microstomia
* Noma
* Oral Crohn's disease
* Orofacial granulomatosis
* Perioral dermatitis
* Pyostomatitis vegetans

Other

* Eagle syndrome
* Hemifacial hypertrophy
* Facial hemiatrophy
* Oral manifestations of systemic disease

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