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Cutaneous verrucous carcinoma: infiltrative tumoral islands of squamous epithelial cells, with deep crypts filled with horny material, destroying the periosteum. HE staining, ×40.
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Verrucous carcinoma is a rare variant of squamous cell carcinoma. It is well differentiated and rarely metastases but can sometimes be very aggressive locally in depth. The paper presents three cases of cutaneous verrucous carcinoma with different localizations. The first patient shows a lesion in the sacrogluteal region, the second one presented a...
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Citations
... VC is most common in the oral cavity and larynx and is highly associated with tobacco use, poor oral hygiene, and HPV [7]. Despite this, it only makes up 2-12% of all oral carcinomas [8]. In less than 10% of cases, it may appear on the ear, lip, face, sole of the foot, bladder, and genitals [3,9]. ...
Verrucous carcinoma (VC) is a variant of cutaneous squamous cell carcinoma. This phenomenon mainly affects the oropharynx, genitalia, and soles of the feet. VC is a well-defined, exophytic, cauliflower-like growth that is warty in nature. Trichoblastoma is a benign epithelial tumor composed of follicular germinative cells. It presents as a small, smooth, non-ulcerated, skin-colored nodule on the scalp, neck, thigh, and perianal regions. The dual presentation of verrucous carcinoma and trichoblastoma of the neck is rare. Though treatment can be achieved through surgical resection, early detection offers a good prognosis.
We present the case of a 54-year-old homeless male who presented with an unusual neck mass that was initially misidentified as an abscess. Surgical debridement was performed, and histopathological analysis revealed the presence of a rare combination of VC and trichoblastoma. This report highlights the challenges of this rare presentation, which may be overlooked or misdiagnosed as an abscess.
... 15 Antigen Ki-67 and tumor protein p53 have been proposed to help differentiate between common plantar verruca, VC, and SCC, but the histologic diagnosis remains challenging, and repeat histopathologic examination often is required. [16][17][18][19] Following diagnosis, computed tomography or magnetic resonance imaging may be necessary to determine tumor extension and assess for deep tissue and bony involvement. [20][21][22] Treatment of EC is particularly challenging because of the anatomic location and need for margin control while maintaining adequate function, preserving healthy tissue, and providing coverage of defects. ...
Epithelioma cuniculatum (EC) is a subtype of verrucous carcinoma (VC) that affects the feet. Treatment involves complete tumor removal by wide local excision (WLE) or Mohs micrographic surgery (MMS). Extensive local destruction may require amputation. We sought to compare reported treatment methods for EC and determine their efficacy by assessing for tumor recurrence and treatment-associated complications. A systematic review of the literature spanning multiple databases was performed. To date, surgical excision is recommended as the standard of care for treatment of EC, with amputation considered in more advanced cases. Mohs micrographic surgery appears to be a promising treatment modality for EC and may have lower recurrence rates than WLE but requires further investigation.
... Se describe al CV como una forma relativamente indolente de CEC. 3 Son predominantes en el sexo masculino y la mayoría de los pacientes son mayores de 60 años en más del 75% de los casos reportados. 4 Se lo ha descrito bajo diversos epónimos; tumor de Buschke-Lowenstein (en la región anogenital), tumor de Ackerman (en la cavidad bucal), y epitelioma cuniculatum (en la planta del pie), siendo este último el más común. 1 Existe una variante de CEC llamada carcinoma condilomatoso (Warty) que aparece en la región genital que presenta rasgos distintivos del CV, pues tiene un comportamiento más agresivo y se relaciona con HPV de alto riesgo oncogénico. 1 Independientemente de su sitio de origen o epónimo, todos los CV comparten características histológicas muy similares, incluyendo un patrón de crecimiento endo-exofítico con marcada acantosis, papilomatosis, hiperqueratosis, y paraqueratosis. Una característica distintiva es que la parte inferior del epitelio forma amplias y redondeadas proyecciones que empujan a la dermis sin los signos clásicos de invasión (es decir, hilos infiltrantes con respuesta estromal desmoplástica como se ve en el CEC convencional). ...
El cáncer de piel no melanoma representa un tercio de todos los tumores malignos de la economía y se espera que su incidencia siga aumentando. El carcinoma cutáneo de células escamosas representa el 20% de todos los cánceres de piel no melanoma y es una amenaza mortal debido a su capacidad de generar metástasis en cualquier órgano del cuerpo. Clínicamente, las lesiones de carcinomas espinocelulares pueden presentarse tanto como una placa asintomática como un tumor verrucoso, que puede crecer, ulcerarse e infectarse. El carcinoma verrugoso de la cavidad bucal presenta una fuerte evidencia de vinculación con el hábito de mascar tabaco y asociación con el virus del papiloma humano (VPH), sobre todo para con los tipos de alto riesgo. Presentamos el caso clínico de un paciente de sexo masculino con carcinoma verrucoso en la mucosa oral. Palabras Clave: carcinoma de células escamosas, carcinoma verrucoso, papiloma virus humano SUMMARY Non-melanoma skin cancer represents one third of all malignant tumors and its incidence is expected to continue increasing. Cutaneous squamous cell carcinoma accounts for 20% of all non-melanoma skin cancers and is a deadly threat due to its ability to metastasize to any organ in the body. Clinically, cutaneous squamous cell carcinoma lesions can occur as well as an asymptomatic plaque such as a warty tumor, which can grow, ulcerate, and become infected. Verrucous carcinoma of the oral cavity presents strong evidence of links to the habit of chewing tobacco and the association with human papiloma virus, especially for high-risk types. We present the clinical case of a male patient with verrucous carcinoma in the oral mucous. INTRODUCCIÓN El carcinoma cutáneo de células escamosas (CEC) incluye muchos subtipos con comportamientos clínicos muy diversos, que van desde tumores indoloros a tumores agresivos con un potencial metastásico significativo. 1 El CEC es el segundo carcinoma más común después del basocelular, y es responsable de la mayoría de las muertes por cáncer de piel no melanoma en Carcinoma epidermoide verrugoso. Presentación de caso clínico y revisión de la literatura Cutaneous verrucous squamous cell carcinoma. Este es un artículo publicado en acceso abierto bajo una Licencia Creative Commons
... Mainly the extensive crypts and ramifying sinuses are histopathologically unique for this type of verrucous carcinoma [8]. Often, keratotic debris is seen within the crypts and sinuses, which are lined with well-differentiated keratinized, stratified, squamous epithelium with hyper-and parakeratosis and a prominent stratum granulosum [6,9,10]. Despite the absence of cellular atypia and normal mitotic figures [6], bony invasion has been reported in several cases [1,11]. ...
... Despite the absence of cellular atypia and normal mitotic figures [6], bony invasion has been reported in several cases [1,11]. Thus, these lesions may display relatively benign histology with concomitant locally invasive behaviour [10]. ...
... Because of the occurrence in weight-bearing areas like the plantar, foot and sacrogluteal region, pressure has also been raised as a potential causative factor [8,10]. This might be caused by obstruction and possible secondary inflammatory changes. ...
A verrucous carcinoma is a rare, low-grade variant of a well-differentiated squamous cell carcinoma (SCC). It frequently occurs in Caucasian males aged 50 to 60. The tumour is locally destructive, grows into muscle, nerves and bones, but rarely metastasizes. Here we report a patient with verrucous carcinoma on the right calcaneus with the uncommon symptom of a haemorrhagic plaque at the centre and also an exophytic component. A 52-year-old man presented with a 10-year-old, progressive, painful, pruritic, exophytic growing, hyperkeratotic and haemorrhagic plaque of 5.2 x 3.5cm on the right calcaneus. The lesion emerged after extensive burns after blast trauma as a child. Excisional biopsy with 2mm margin in combination with clinical presentation favoured a verrucous carcinoma. The pathology report showed that the tumour was not excised radically; therefore, re-excision with 5mm margin was required and was performed two months later. The wound was closed with a medial plantar artery perforator (MPAP) flap. The donor site was closed with a full-thickness skin graft (FTSG) from the medial side of the right upper leg and was covered by a tie-over bandage. Verrucous carcinoma is a rare tumour and can be adequately surgically treated by excision with clear margins. In this case, the verrucous carcinoma of the right calcaneus was excised and reconstructed with an MPAP flap with decent results, despite a challenging postoperative course.
... Surgical excision with 4mm margins is recommended. Very few cases have been documented in the ear (20). ...
Introduction and Aim: Most of the lesions affecting pinna are cutaneous conditions. Those arising from the cartilage are extremely rare, whereas those from the soft tissue like vascular, stromal and adnexal components are relatively common. The present study aims at analysing the proportion, types, and categories of lesions affecting the pinna. Methods: Following institutional ethics committee approval, a retrospective analysis of medical records of 40 patients who underwent surgical excision of pinna lesions from 2006 to 2018 was conducted at a tertiary care hospital in Dakshina Kannada, India. Lesions were grouped as benign adnexal, benign soft tissue, malignant lesions, and infection/inflammation. Results: Median age was 47.5 years and mode was 59 years. There were thirty (75%) males and ten (25%) females. The commonest lesions included epidermal cyst (25%), followed by seborrhoeic keratosis (17.5%), and squamous cell carcinoma (10%). Conclusion: A wide spectrum of entities affecting the pinna were encountered in the present study. Superficial cystic lesions are the most frequent type found in pinna and are amenable to simple excision. Benign neoplasms require surgical intervention; malignancy is also to be kept in mind while making a clinical diagnosis, necessitating wide clearance with or without neck dissection. Early intervention and confirmation of diagnosis by histopathological examination helps not only in successful management but also in preventing disfigurement and psychosocial complications.
... While the tumor generally has a good survival prognosis, it can be locally aggressive and may recur after treatment. The mortality with VC is more often due to local invasion rather than metastases [97] . VC usually presents as a warty, exophytic, non-ulcerating lesion with a red/white surface, making it difficult to clinically distinguish from other similar appearing dermatologic conditions. ...
Melanoma and non-melanoma cutaneous malignancies are some of the leading causes of cancer-related death in the United States. Though melanoma is more known to have a high mortality rate, the total mortality per year is nearly equal for between melanoma and non-melanoma skin cancer. Moreover, the non-melanoma types of cutaneous malignancies have potential to become locally invasive and even metastasize with very little to no treatment options when advanced. The development of these malignancies involves various genetic pathways through the four hallmarks of cancer development: malignant cell growth, apoptosis evasion, the use of supporting stroma and vascularization, and modulating and promoting an inadequate immune response. The genetic signaling pathways of basal cell carcinoma, squamous cell carcinoma, verrucous carcinoma, basosquamous cell carcinoma, melanoma, and cutaneous T-cell lymphoma interact with each other through genetic predisposition as well as with environmental exposures. Furthermore, solar ultraviolet radiation and chronic inflammatory states are found to initiate the progression of many of these cutaneous malignancies. This paper includes validated models of genetic pathways, emerging pathways, and crosstalk between genetic pathways through the four hallmarks of cancer development. Moreover, unlike most reviews addressing oncogenetics of the well-recognized, as well as newly discovered, genetic pathway mutations, this review stresses that these pathways are not fixed but rather exist in dynamic, interrelated, interactive, complex, and adaptive flux states.
... The awareness of this entity is necessary and a vigilant search for areas with SCC should be performed. [22] Hybrid carcinomas should be staged and managed as conventional SCC because they show excellent prognosis following complete surgical removal in the early stages contrary to classical VC. [23] BCC The frequency of BCC with respect to malignancies of skin was lower in the study done by Adinarayan and Krishnamurthy. [19] and Chalya et al., [20] whereas it was much higher in the study by Soomro et al. [17] In the present study, BCC was most commonly found in the seventh decade (44.44%). ...
Objective:
Skin cancers are relatively uncommon malignancies worldwide, but there is a progressive increase in the incidence over the last few decades.
Methods:
We have studied the clinical and histopathological features of malignant skin tumors received in the department of pathology of our tertiary care institute over a period of 3 years and 8 months. A detailed analysis of clinical, gross, and microscopic findings was performed, followed by clinicopathological correlation.
Results:
One hundred and one specimens of skin tumors were received during this period, of which 37 (36.27%) were malignant tumors. Keratinocytic tumors were most common (81.08%) followed by appendageal tumors (10.81%). Squamous cell carcinoma (SCC) was the most frequent malignancy followed by basal cell carcinoma (BCC). Malignant melanoma, hidradenocarcinoma, malignant proliferating trichilemmal tumor (MPTT), sebaceous carcinoma, and fibrosarcomatous dermatofibrosarcoma were also observed. Variants such as hybrid verrucous SCC, basosquamous carcinoma, infiltrating BCC, and MPTT with spindle SCC were also found. Malignant skin tumors were most frequent in the seventh decade (40.54%). Males and females were almost equally affected. Overall, head and neck region was the most common site for malignant skin tumors.
Conclusion:
The vast diversity of skin tumors produces difficulty in diagnosis. Any lesion, for which the diagnosis is uncertain, based on the history and clinical examination, should be biopsied for histopathological examination to rule out malignancy.
... Verrucous carcinoma is an epithelial lesion characterized by papillomatosis and low-degree of cytologic atypia [39]. Since they are more commonly seen in sensitive areas (penis, vulva) sometimes the biopsies are superficial, and thus do not allow to observe the characteristic blunt, wide shape of the rete ridges. ...
Although all diagnoses in dermatopathology are important, three main groups may be highlighted. One group includes diagnoses that need to be communicated to the treating physician as soon as possible (this review includes infectious process while erythema multiforme and related diseases are discussed elsewhere in this series). A second group has diagnoses significant for their association with syndromes or internal malignancies. And a third group includes malignant lesions that can be confused histologically with benign ones or lesions that have an aggressive behavior unexpected for their apparently low-grade histology. This manuscript describes some of these important diseases and the method we use to reach the diagnosis, and as such it may be considered to be a “survival” guide for the dermatopathologist.
... Верукозният карцином се смята за тумор, който има нисък малигнен потенциал и рядко метастазира [8]. Въпреки това в редки случаи е възможно да премине в спиноцелуларен карцином или in situ сквамоцелуларен карцином [4]. ...
Non-melanoma skin cancer comprises the two most common forms of malignant neoplasms found in humans, namely, basal cell carcinoma and squamous cell carcinoma. Seborrheic keratosis is one of the commonest benign epidermal skin lesions that appear in middle-aged or elderly people. Other common epidermal tumors in this chapter include melanoacanthoma, skin tags, dermatosis papulosa nigra, stucco keratosis, and cutaneous horn. Different types of keratoses will be reviewed such as actinic, lichenoid, and lymphomatoid and keratoses related to chronic exposure to arsenic and tar or after radiation therapy. Also acanthomas, namely, clear cell and large cell, and porokeratoma, an acanthoma with porokeratotic characteristics. Other entities are also disseminated superficial actinic porokeratosis, actinic cheilitis, pseudoepitheliomatous hyperplasia, and HPV-related tumors such as Bowenoid papulosis. Three different rare genodermatoses will be described, namely, nevoid BCC syndrome (Gorlin-Goltz’s syndrome), Rombo syndrome, and xeroderma pigmentosum. It is important to learn how to early recognize and diagnose these tumors and genodermatoses. Based on their characteristic features outlined in this chapter and clinical behavior, clinicians can guarantee patients’ appropriate treatment options with less morbidity, better outcomes, and overall prognosis.
