Verrucous carcinoma

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Synonyms and Keywords: Ackerman tumor; Verrucous carcinoma of the skin

Overview

Verrucous carcinoma (also known as "Snuff dipper's cancer") is rare subtype of squamous cell carcinoma.[1] Common causes of verrucous carcinoma, include: tobacco chewing, or use snuff orally. Patients with oral verrucous carcinoma may be at greater risk of a second oral squamous cell carcinoma. 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.[2] Verrucous carcinoma is most commonly seen among male patients between 50 to 80 years, and the median age at diagnosis is 67 years.[3][4] The diagnosic criteria for verrucous carcinoma is biopsy and surgical excision must provide adequate specimens including the full thickness of the tumors and adjacent uninvolved mucosa for correct diagnosis.[5]

Historical Perspective

  • Verrucous carcinoma was first discovered by Lauren V. Ackerman, an American physician in 1948.[6]

Classification

  • Verrucous carcinoma may be classified into 5 subtypes:
  • Epithelioma cuniculatum (Ackerman tumor, carcinoma cuniculatum)
  • Buschke–Löwenstein tumor (giant condyloma)
  • Oral florid papillomatosis
  • Subungual keratoacanthoma
  • Gottron's carcinoid papillomatosis

Pathophysiology

  • Verrucous carcinoma is characterized as a well-differentiated squamous cell carcinoma with minimal metastatic potential.[7]
  • The pathogenesis of verrucous carcinoma is not fully understood.[7]
  • Different locations of verrucous carcinoma, include:[7]
  • There are no genetic mutations associated with the development of verrucous carcinoma.
  • On gross pathology, characteristic findings of verrucous carcinoma include:[8]
  • Cauliflower-like, exophytic mass
  • On microscopic histopathological analysis, characteristic findings of verrucous carcinoma include:[8]
  • Exophytic growth
  • Well-differentiated
  • "Glassy" appearance
  • Pushing border - described "elephant feet"

Causes

  • Common causes of verrucous carcinoma, include:[9]
  • Use snuff orally
  • Tobacco chewing
  • Chewing betel nuts (Taiwan)
  • Alcohol consumption

Differentiating Verrucous Carcinoma from Other Diseases

  • Verrucous carcinoma must be differentiated from other diseases that cause leukoplakic patches, such as:[9]
  • Keratoacanthoma
  • Giant verruca vulgaris
  • Nongenital warts
  • Pyoderma vegetans

Epidemiology and Demographics

  • Verrucous carcinoma is very uncommon

Age

  • Verrucous carcinoma is more commonly observed among patients aged 50 to 80 years old.
  • Verrucous carcinoma is more commonly observed among middle-aged and elderly adults.[8]

Gender

  • Males are more commonly affected with verrucous carcinoma than females.

Race

  • Verrucous carcinoma usually affects individuals of the Asian race.[8]

Risk Factors

  • The most common risk factor in the development of verrucous carcinoma is human papillomavirus (HPV) infection. Other factors, such as schistosomiasis infections, are related to bladder verrucous carcinoma.[9]

Natural History, Complications and Prognosis

  • The majority of patients with verrucous carcinoma remain asymptomatic for years.
  • Early clinical features include translucent patches with erythematous base, and pruritus.
  • If left untreated, patients with verrucous carcinoma may progress to develop malignant transformation.[9]
  • Common complications of verrucous carcinoma, include:
  • Prognosis is generally good, and the 5-survival rate of patients with verrucous carcinoma is approximately 75-80%.[9]

Diagnosis

Symptoms

  • Verrucous carcinoma is usually asymptomatic.
  • Symptoms of verrucous carcinoma may include the following:[8]
  • Painful lymphadenopathy
  • Non-healing scar
  • Pruritus

Physical Examination

  • Patients with verrucous carcinoma usually appear malnourished.
  • Physical examination may be remarkable for:[8]
  • Slow growing, diffuse, exophytic lesion
  • Leukoplakic patches
  • Enlarged regional lymph nodes.
  • Painful multiple rugae-like folds and deep clefts.

Gallery

Laboratory Findings

  • There are no specific laboratory findings associated with verrucous carcinoma.[9]

Imaging Findings

  • There are no specific imaging findings for verrucous carcinoma.

Treatment

Medical Therapy

  • The mainstay of therapy for verrucous carcinoma, may include:[11]

Surgery

  • Surgery is the mainstay of therapy for verrucous carcinoma.
  • Complete surgical excision (Mohs surgery) is the most common approach to the treatment of verrucous carcinoma.[8]

Prevention

  • Primary preventive measures available for verrucous carcinoma, include:[8]
  • Avoid chewing tabacco
  • Once diagnosed and successfully treated, patients with verrucous carcinoma are followed-up every 3, or 12 months.
  • Follow-up testing, include: regular skin examinations.

References

  1. 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.
  2. 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
  3. Tornes K, Bang G, Koppang HS, Pedweson KN. Oral verrucous carcinoma. Int J Oral Surg 1985;14:485-92
  4. 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
  5. McDonald JS, Crissman JD, Gluckman JL. Verrucous Carcinoma of the oral cavity. Head Neck Surg 1982;5:22-8
  6. Lauren Ackerman. Wikipedia. https://en.wikipedia.org/wiki/Lauren_Ackerman. Accessed on May 11, 2016
  7. 7.0 7.1 7.2 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
  8. 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 Klima M, Kurtis B, Jordan PH (1980). "Verrucous carcinoma of skin". J. Cutan. Pathol. 7 (2): 88–98. PMID 7372883. 
  9. 9.0 9.1 9.2 9.3 9.4 9.5 Schwartz RA (1995). "Verrucous carcinoma of the skin and mucosa". J. Am. Acad. Dermatol. 32 (1): 1–21; quiz 22–4. PMID 7822496. 
  10. 10.0 10.1 "Dermatology Atlas". 
  11. Alkan A, Bulut E, Gunhan O, Ozden B (2010). "Oral verrucous carcinoma: a study of 12 cases". Eur J Dent. 4 (2): 202–7. PMC 2853822Freely accessible. PMID 20396454. 

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