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Verrucous carcinoma
See also in: Oral Mucosal Lesion
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Verrucous carcinoma

See also in: Oral Mucosal Lesion
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Contributors: Gabriela Ulloa, Loren Krueger MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Verrucous carcinoma is an uncommon subtype of squamous cell carcinoma (SCC). Other names include verrucous squamous cell carcinoma and papillomatosis cutis carcinoides. Verrucous carcinoma presents as a well-defined, slow-growing, cauliflower-like tumorous plaque that resembles large verruca. It has been found to be associated with human papillomavirus (HPV) 16, 18, and less commonly 6 and 11. Non-HPV-associated tumors have also been reported. Verrucous carcinoma is thought to have low potential for metastasis.

Many cases of verrucous carcinoma occur in the setting of scars, amputations, and chronic inflammation. Subtypes of verrucous carcinoma are seen in particular anatomic locations:

Localized Areas of Tumor Presentation:
  • Plantar foot (epithelioma cuniculatum) – Commonly develops on the ball of the foot; can destroy underlying bony structures.
  • Oral cavity (oral verrucous carcinoma, Ackerman tumor) – See Verrucous carcinoma – Oral Mucosal Lesion.
  • Anogenital region (giant condyloma of Buschke-Loewenstein) – Typically more aggressive; consider underlying immunosuppression. See Buschke-Lowenstein tumor.
  • Nail bed (rare) – Onycholysis and shedding of the nail plate are at times present.
Verrucous carcinoma occurs more commonly in men, with a reported increased prevalence ratio of 4:1-9:1. Commonly, tumors present with slow, persistent growth over years; mean time to presentation is 13 years. Patients may experience symptoms including pain, pressure, and drainage from the keratin-filled sinuses, especially with plantar tumors. Metastases are rare due to slow, exophytic growth; however, there are rare reports of nodal and distant metastasis. Many of these cases have occurred after radiation therapy-induced anaplastic transformation of the tumor.

Codes

ICD10CM:
C44.320 – Squamous cell carcinoma of skin of unspecified parts of face
D04.9 – Carcinoma in situ of skin, unspecified

SNOMEDCT:
89906000 – Verrucous Carcinoma

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The differential diagnosis of cutaneous verrucous carcinoma is broad, owing to its clinical similarity to verruca vulgaris. Pain, drainage, and lack of response to treatment should prompt further investigation with histopathologic correlation.
  • Verruca vulgaris (common wart) – Look for black dots indicating thrombosed vessels on paring.
  • Cutaneous squamous cell carcinoma – Differentiated on histology based on cellular atypia, invasive growth pattern, and mitotic activity.
  • Amelanotic melanoma – Usually faster growing than verrucous carcinoma.
  • Deep fungal infections – Characteristic geographic locations for coccidioidomycosis and blastomycosis may raise suspicion.
  • Halogenoderma (bromoderma, iododerma) – If patients take medications containing bromine or iodine or have a history of ingestion or a recent radiology procedure.
  • Epidermal inclusion cyst – May see a single center punctum that occasionally drains curdy, white material.
  • Other epidermal and adnexal tumors – Multiple benign and malignant tumors may be clinical mimickers based on the location of the tumor, including seborrheic keratosis and poroma.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 01/18/2018
Last Updated: 01/18/2018
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Verrucous carcinoma
See also in: Oral Mucosal Lesion
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Verrucous carcinoma (Skin) : Skin ulcer, Verrucous scaly papule, Verrucous scaly plaque
Clinical image of Verrucous carcinoma
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