|Rare appearance on foot. An exophytic and hyperkeratotic mass that discharged malodorous debris through several sinus tracts|
|Classification and external resources|
Verrucous carcinoma (VC) 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 may occur in various head and neck locations, as well as in the genitalia. The oral cavity is the most common site of this tumor. The ages range from 50 to 80 years with a male predominance and a median age of 67 years. VC may grow large in size, resulting in the destruction of adjacent tissue, such as bone and cartilage. 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.
Surgery is considered as the treatment of choice, but the extent of surgical margin and the adjuvant radiotherapy are still controversial.
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. The presentation of VC originated from exposure to different carcinogens may not be the same.
Signs and symptoms
- 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.
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.
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Surgical excision or laser therapy are possible treatments. Surgical excision alone was effective for controlling VC, but elective neck dissection was not necessary even in patients in the advanced stages.
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- 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