Verrucous carcinoma
See also in: Oral Mucosal LesionAlerts and Notices
Synopsis
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.
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
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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.
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References
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Last Reviewed:01/17/2018
Last Updated:01/17/2018
Last Updated:01/17/2018
Verrucous carcinoma
See also in: Oral Mucosal Lesion