Verrucous carcinoma (VC) is an uncommon variant of
squamous cell carcinoma.
This form of cancer is often seen in those who chew
tobacco
Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ...
or use
snuff
Snuff may refer to:
Tobacco
* Snuff (tobacco), fine-ground tobacco, sniffed into the nose
** Moist snuff or dipping tobacco
** Creamy snuff, an Indian tobacco paste
Media and entertainment
* Snuff film, a type of film that shows a murder
Literat ...
orally, so much so that it is sometimes referred to as "Snuff dipper's cancer".
Signs and symptoms
* Ageusually over 60 years old
* Sexmales are more prone
* Sitegingiva, buccal mucosa,
alveolar mucosa
The oral mucosa is the mucous membrane lining the inside of the mouth. It comprises stratified squamous epithelium, termed "oral epithelium", and an underlying connective tissue termed '' lamina propria''. The oral cavity has sometimes been des ...
, 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.
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 sole is the bottom of the foot.
In humans the sole of the foot is anatomically referred to as the plantar aspect.
Structure
The glabrous skin on the sole of the foot lacks the hair and pigmentation found elsewhere on the body, and it has ...
. 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.
Diagnosis
Surgeons must provide adequate specimens including the full thickness of the tumors and adjacent uninvolved mucosa for correct
histopathology
Histopathology (compound of three Greek words: ''histos'' "tissue", πάθος ''pathos'' "suffering", and -λογία '' -logia'' "study of") refers to the microscopic examination of tissue in order to study the manifestations of disease. Spe ...
diagnosis.
- "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."[
]
Subtypes
Epithelioma cuniculatum (also known as Carcinoma cuniculatum,
[.] and Ackerman tumor
) is a subtype of verrucous carcinoma,
characterized by well-differentiated epithelial cells which lack cytological
atypia
Atypia (from Greek, ''a'' + ''typos'', without type; a condition of being irregular or nonstandard) is a histopathologic term for a structural abnormality in a cell, i.e. it is used to describe atypical cells.
Atypia can be caused by an infection ...
, but display a blunt papillary/pebbly surface and keratin-filled crypts extending deep into the connective tissue.
These keratin-filled resemble rabbit burrows.
It is located almost exclusively on the foot,
but at least oral location has also been described.
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.
Prognosis
Most patients with verrucous carcinoma have a good prognosis. Local recurrence is not uncommon, but
metastasis
Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, then, ...
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
*
List of cutaneous conditions
Many skin conditions affect the human integumentary system—the organ system covering the entire surface of the body and composed of skin, hair, nails, and related muscle and glands. The major function of this system is as a barrier against t ...
*
List of verrucous carcinoma subtypes
Verrucous carcinoma is a type of squamous cell carcinoma that may be associated with HPV infection (may be subtypes 16 or 18, but types 6 and 11 have also been reported, as have HPV negative variants). Several subtypes of verrucous carcinoma hav ...
References
External links
eMedicine.com article
{{Oral pathology
Epidermal nevi, neoplasms, and cysts
Carcinoma
Oral mucosal pathology
Oral neoplasia