Verrucous carcinoma

Verrucous carcinoma (VC) is an uncommon variant of squamous cell carcinoma.[1] 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".

See also: List of verrucous carcinoma subtypes
Verrucous carcinoma
Verrucous carcinoma on the penis
SpecialtyOncology Edit this on Wikidata

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.

Cause

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.

Risk factors

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.[2][3][4][5]

The presentation of VC originated from exposure to different carcinogens may not be the same.

Locations

Verrucous carcinoma may occur in various head and neck locations, as well as in the genitalia or sole of the foot. The oral cavity is the most common site of this tumor.[6] The ages range from 50 to 80 years with a male predominance and a median age of 67 years.[7] VC may grow large in size, resulting in the destruction of adjacent tissue, such as bone and cartilage.[8]

Diagnosis

Surgeons must provide adequate specimens including the full thickness of the tumors and adjacent uninvolved mucosa for correct histopathology diagnosis.[9]

  • Low-magnification micrograph of penile verrucous carcinoma. The tumor is characterized by prominent papillomatosis.
    Low-magnification micrograph of penile verrucous carcinoma. The tumor is characterized by prominent papillomatosis.[10]
  • High magnification. There is prominent acanthosis. The tumor front is broad-based and pushes the subepithelial tissues.
    High magnification. There is prominent acanthosis. The tumor front is broad-based and pushes the subepithelial tissues.[10]

Subtypes

Epithelioma cuniculatum (also known as Carcinoma cuniculatum,[11]: 654  and Ackerman tumor[12]) is a subtype of verrucous carcinoma,[13] characterized by well-differentiated epithelial cells which lack cytological atypia, but display a blunt papillary/pebbly surface and keratin-filled crypts extending deep into the connective tissue.[14] These keratin-filled crypts resemble rabbit burrows.[14] It is located almost exclusively on the foot,[13] but at least 50 oral locations have also been observed.[14]

Treatment

Surgery is considered the treatment of choice, but the extent of surgical margin and the adjuvant radiotherapy are still controversial.

Surgical excision alone is effective for controlling VC, but elective neck dissection is not necessary even in patients in the advanced stages.[7]

Prognosis

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.

See also

References
  1. Ridge JA, Glisson BS, Lango MN, Feigenberg S, Horwitz EM (2008). "Head and Neck Tumors". In Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (eds.). Cancer Management: A Multidisciplinary Approach (11th ed.).
  2. Xu J, Gimenez-Conti IB, Cunningham JE, Collet AM, Luna MA, Lanfranchi HE, et al. (July 1998). "Alterations of p53, cyclin D1, Rb, and H-ras in human oral carcinomas related to tobacco use". Cancer. 83 (2): 204–212. doi:10.1002/(sici)1097-0142(19980715)83:2<204::aid-cncr2>3.0.co;2-q. PMID 9669801.
  3. Saranath D, Chang SE, Bhoite LT, Panchal RG, Kerr IB, Mehta AR, et al. (April 1991). "High frequency mutation in codons 12 and 61 of H-ras oncogene in chewing tobacco-related human oral carcinoma in India". British Journal of Cancer. 63 (4): 573–578. doi:10.1038/bjc.1991.133. PMC 1972357. PMID 2021541.
  4. Yeudall WA, Torrance LK, Elsegood KA, Speight P, Scully C, Prime SS (January 1993). "Ras gene point mutation is a rare event in premalignant tissues and malignant cells and tissues from oral mucosal lesions". European Journal of Cancer, Part B. 29B (1): 63–67. doi:10.1016/0964-1955(93)90012-4. PMID 8180579.
  5. Kuo MY, Jeng JH, Chiang CP, Hahn LJ (February 1994). "Mutations of Ki-ras oncogene codon 12 in betel quid chewing-related human oral squamous cell carcinoma in Taiwan". Journal of Oral Pathology & Medicine. 23 (2): 70–74. doi:10.1111/j.1600-0714.1994.tb00259.x. PMID 8164156.
  6. Medina JE, Dichtel W, Luna MA (July 1984). "Verrucous-squamous carcinomas of the oral cavity. A clinicopathologic study of 104 cases". Archives of Otolaryngology. 110 (7): 437–440. doi:10.1001/archotol.1984.00800330019003. PMID 6732584.
  7. Kang CJ, Chang JT, Chen TM, Chen IH, Liao CT (November 2003). "Surgical treatment of oral verrucous carcinoma". Chang Gung Medical Journal. 26 (11): 807–812. PMID 14765750.
  8. Koch BB, Trask DK, Hoffman HT, Karnell LH, Robinson RA, Zhen W, Menck HR (July 2001). "National survey of head and neck verrucous carcinoma: patterns of presentation, care, and outcome". Cancer. 92 (1): 110–120. doi:10.1002/1097-0142(20010701)92:1<110::aid-cncr1298>3.0.co;2-k. PMID 11443616.
  9. McDonald JS, Crissman JD, Gluckman JL (1982). "Verrucous carcinoma of the oral cavity". Head & Neck Surgery. 5 (1): 22–28. doi:10.1002/hed.2890050106. PMID 6757186.
  10. Philippou P, Kitsios C, Miliatou M, Poullou C, Konstantinou P (2019). "Organ-Sparing Surgery for a Giant Verrucous Carcinoma of the Penile Shaft: A Case Report and Review of the Literature". Case Reports in Urology. 2019: 1537379. doi:10.1155/2019/1537379. PMC 6408996. PMID 30918740.
    - "This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited."
  11. James W, Berger T, Elston D (2005). Andrews' Diseases of the Skin: Clinical Dermatology (10th ed.). Saunders. ISBN 0-7216-2921-0..
  12. Rapini RP, Bolognia JL, Jorizzo JL (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
  13. Suen K, Wijeratne S, Patrikios J (December 2012). "An unusual case of bilateral verrucous carcinoma of the foot (epithelioma cuniculatum)". Journal of Surgical Case Reports. 2012 (12): rjs020. doi:10.1093/jscr/rjs020. PMC 3855215. PMID 24968418.
  14. Datar UV, Kale A, Mane D (January 2017). "Oral Carcinoma Cuniculatum: A New Entity in the Clinicopathological Spectrum of Oral Squamous Cell Carcinoma". Journal of Clinical and Diagnostic Research. 11 (1): ZD37–ZD39. doi:10.7860/JCDR/2017/23437.9226. PMC 5324519. PMID 28274074.
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