Cutaneous Squamous Cell Carcinoma Masquerading as a Verruca: Case Report and Literature Review of Coexisting Wart and Invasive Squamous Cell Carcinoma on the Hand

Abstract

A verruca is a human papillomavirus-associated infection of the mucosal or cutaneous epithelium. Cutaneous squamous cell carcinoma is an invasive skin cancer that commonly occurs on sun-exposed locations. Human papillomavirus infection has also been demonstrated to be a cocarcinogen, along with ultraviolet radiation, in the pathogenesis of cutaneous squamous cell carcinoma. A 63-year-old man presented with a verrucous nodule of nine months duration on his dorsal left hand. The clinical differential diagnosis included a wart and a small punch biopsy of the lesion showed a verruca. The lesion continued to enlarge and the possibility of a squamous cell carcinoma was considered. A second larger shave biopsy of the residual lesion was performed and the microscopic evaluation revealed not only a benign verruca at the lateral portion of the nodule but also an invasive squamous cell carcinoma in the center of the lesion. We hypothesize that the patient's human papillomavirus-associated wart may have contributed to the development of his cutaneous squamous cell carcinoma. Therefore, in an individual with a clinically suspected or biopsy-confirmed wart that persists despite lesion-directed treatment, additional evaluation of the lesion should be considered to assess whether an alternative or concurrent tumor, such as a cutaneous squamous cell carcinoma, is present.

Unusual Clinical Presentation of Cutaneous Squamous Cell Carcinoma: a Retrospective Study in Al Baha Region, Southern Saudi Arabia

“…The clinical presentation of cSCC varies from skin induration, nodules, ulcerations, unusual pigmentation and warty lesions similar to verrucas. In rare incidences, cSCC may masquerades as a verruca, and an accurate diagnosis is crucial to prevent the spread of the cancer and ensuing complications [19].…”

Basal cell carcinoma in situ of the skin revisited: case reports of the superficial type and fibroepithelioma type of this in situ cutaneous neoplasm

“…Squamous cell carcinoma, malignant melanoma, and Merkel cell carcinoma are invasive cutaneous tumors [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. In contrast, in situ variants of these malignancies are characterized by neoplasms in which tumor cells are restricted to the epidermis [3,7,8,[18][19][20][21][22][23][24][25][26][27][28][29][30][31].…”