Verrucous carcinoma

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Verrucous carcinoma
Penile verrucous carcinoma.jpg
Verrucous carcinoma on the penis

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".

Signs and symptoms

Carcinoma cuniculatum, subtype
  • 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.

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.


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]


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


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 resemble rabbit burrows.[14] It is located almost exclusively on the foot,[13] but at least oral location has also been described.[14]


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.[15]


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


  1. Ridge JA, Glisson BS, Lango MN, et al. "Head and Neck Tumors" Archived 2009-07-20 at the Wayback Machine in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach Archived 2013-10-04 at the Wayback Machine. 11 ed. 2008.
  2. 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
  3. 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
  4. 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
  5. 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.
  6. 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
  7. Tornes K, Bang G, Koppang HS, Pedweson KN. Oral verrucous carcinoma. Int J Oral Surg 1985;14:485-92
  8. 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
  9. McDonald JS, Crissman JD, Gluckman JL. Verrucous Carcinoma of the oral cavity. Head Neck Surg 1982;5:22-8
  10. 10.0 10.1 Philippou, Prodromos; Kitsios, Christos; Miliatou, Maria; Poullou, Christiana; Konstantinou, Pavlos (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. ISSN 2090-696X. 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, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
  12. Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
  13. 13.0 13.1 Suen, K.; Wijeratne, S.; Patrikios, J. (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. ISSN 2042-8812. PMC 3855215. PMID 24968418.
  14. 14.0 14.1 14.2 Datar, Uma Vasant (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. ISSN 2249-782X. PMC 5324519. PMID 28274074.
  15. Chang Gung Med J 2003;26:807-12

Further reading

External links

External resources