|Classification and external resources|
Verrucous carcinoma is an uncommon variant of squamous cell carcinoma. 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."
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.
Verrucous carcinoma (VC) is a variant of squamous cell carcinoma, which is a low-grade malignance that rarely presents with distant metastasis. VC may occur in several locations in the head and neck and in the genitalia. The oral cavity is the most common site of this tumor(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). The ages range from 50 to 80 years with a male predominance and the median age is 67 years(Tornes K, Bang G, Koppang HS, Pedweson KN. Oral verrucous carcinoma. Int J Oral Surg 1985;14:485-92). VC may grow very large and can destroy adjacent tissue such as bone and cartilage(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). The diagnosis of VC is established by close communication between surgeons and pathologists. Surgeons must provide adequate specimens including the full thickness of the tumors and adjacent uninvolved mucosa for correct diagnoses(McDonald JS, Crissman JD, Gluckman JL. Verrucous Carcinoma of the oral cavity. Head Neck Surg 1982;5:22-8).
Surgery is considered as the treatment of choice, but the extent of surgical margin and the adjuvant radiotherapy are still controversial.
Exposure to carcinogens is different between Western countries and Taiwan (where the following study was performed). The major carcinogens in Western countries come from cigarette smoking and alcohol use, however, in Taiwan, betel nut use is another source in addition to cigarette smoking and alcohol use. The different gene mutations have been reported in head and neck cancer comparing with Western countries(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; 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; 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; 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.) The clinical behavior of VC according to exposure to different carcinogens may not be the same.
It is a diffuse, papillary, non metastasizing, well differentiated, malignant neoplasm of epidermis or oral epithelium. Several subtypes have been described.
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."
- 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 Leukoplakik 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.
Surgical excision or laser therapy are possible treatments.
Related Study (in Taiwan)
A study on VC as 'Surgical Treatment of Oral Verrucous Carcinoma' has been carried out by Chung-Jan Kang, MD; Joseph Tung-Chieh Chang1, MD; Tsung-Ming Chen, MD;I-How Chen, MD; Chun-Ta Liao, MD.
The aim of this study was to evaluate the outcome of patients with Verrucous carcinoma (VC) of oral cavity treated at the Chung Gung Memory Hospital with respect to the tumor control rates after surgery, the risk of lymph node metastasis and the role of radiation therapy.
Thirty-eight patients underwent primary treatment for VC of the oral cavity from January 1996 through February 2002. All of the patients had surgery as their primary treatment. In addition, all patients with sufficient details of the therapy and a minimum 1-year follow-up were selected for evaluation of survival and outcomes.
In the study, 94.7% of patients were male and most of them had been exposed to betel nuts, cigarettes, and/or alcohol. The most common site was the buccal mucosa (57.9%), followed by the tongue (13.2%). T3 lesions were the most common type (34.2%). Only two patients had palpable cervical adenopathy during the initial evaluation. Twenty-five patients had free flap for reconstruction. The tumor control rate was 100%. At the time of analysis, no patient had suffered from recurrence in primary site or neck area.
Surgical excision alone was effective for controlling VC, but elective neck dissection was not necessary even in patients in the advanced stages(Chang Gung Med J 2003;26:807-12).
- Ridge JA, Glisson BS, Lango MN, et al. "Head and Neck Tumors" in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach. 11 ed. 2008.
- Chung-Jan Kang, MD; Joseph Tung-Chieh Chang1, MD; Tsung-Ming Chen, MD;I-How Chen, MD; Chun-Ta Liao, MD .
- eMedicine.com article
- Maxillofacial Center for Education & Research article
- Cancer Management Handbook: Head and Neck Tumors
- 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
- Verrucous Carcinoma (VC) Pictures