Cutaneous verrucous carcinoma: A clinicopathological study of 21 cases with long-term clinical follow-up

Abstract

BackgroundCutaneous verrucous carcinoma (CVC) is a rare variant of squamous cell carcinoma and sometimes shares similar clinical and histopathological features with other verrucous lesions.MethodsWe performed a retrospective study of 21 patients diagnosed with CVC between 2012 and 2022 by reviewing clinical and histopathological data. We also compared the clinicopathological features of patients with CVC, giant condyloma acuminatum (GCA), and pseudoepitheliomatous hyperplasia (PEH). We obtained follow-up data by reviewing medical records and telephone interviews.ResultsThe average age of patients with CVC was 63.6 years, with a male predominance. The location of disease is mostly found in the foot, followed by the lower legs. Histologically, CVC is characterized by an exo-endophytic growth pattern with severe keratinization and a blunted rete ridge with pushing margins. Clinical features including exudation and crusting, induration, irregular borders, and warty surface, as well as pathological features including growth pattern, koilocytotic cells, depth and morphologic features of acanthosis, severe keratinization, and degree of dermal inflammation, were significant in distinguishing cutaneous CVC, GCA, and PEH.ConclusionIdentification of the clinicopathological features is essential to distinguish CVC from its mimics and to make an early diagnosis. Because of the potential for recurrence and metastasis, CVC requires aggressive treatment.

A huge verrucous carcinoma of the lower lip reconstructed by double Abbe flap: A case report and literature review

“…The most typical pathological features of VC are broad-based, well differentiated exophytic and endophytic epithelial proliferations with marked surface keratinization, without cellular atypia, invading the stroma with pushing borders ( 1 ). VC is comparable to many diseases in clinical and pathological conditions and deserves cautious differentiation, such as verrucous hyperplasia, squamous papilloma, and conventional squamous cell carcinoma ( 1 , 10 ). Among them, squamous cell carcinoma, with varying degrees of cell atypia, has a potential proclivity to metastasize and carries a relatively dismal prognosis ( 10 , 11 ).…”

“…VC is comparable to many diseases in clinical and pathological conditions and deserves cautious differentiation, such as verrucous hyperplasia, squamous papilloma, and conventional squamous cell carcinoma ( 1 , 10 ). Among them, squamous cell carcinoma, with varying degrees of cell atypia, has a potential proclivity to metastasize and carries a relatively dismal prognosis ( 10 , 11 ). Although the prognosis of lip verrucous carcinoma is much better than other types of life-threatening malignancies, as a facially disfiguring disease, the particular location and the freakish appearance of lesions seriously affect patients’ mental health and quality of life.…”

Cutaneous Verrucous Carcinomas: A Review

“…The overall presentation of CVC is a prominent exo-endophytic growth pattern with blunt reticular ridges and pushing edges. 47 The epidermis shows prominent hyperkeratosis, parakeratosis, and papillary hyperplasia, with tight hyperkeratosis usually filling the interstices of the verrucous protrusions. 48 Irregular epidermal hyperplasia is composed mainly of well-differentiated eosinophilic keratinocytes that are large, with abundant cytoplasm, little nuclear atypia, and mixed with a minority of clear cells.…”

“…54 Reactive hyperplasia can be observed on the sides of the non-invasive epithelium adjacent to the tumor, manifesting as irregular acanthosis. 47 CVC sometimes shows abnormal maturation, cellular and nuclear atypia, and increased mitotic activity when growth is disturbed by factors such as pressure, and these cells easily penetrate the basement membrane. 49,55 This is particularly seen in CVC of the foot, which usually presents an endophytic growth pattern pathologically with thickening of the epidermis with elongation of rete ridges and sinus formation.…”

“…Differential diagnosis includes verruca vulgaris and GCA, keratoacanthoma (KA), PEH and SCC. 2,47,49 Verruca vulgaris presents as papillae growing outward from a central lesion projecting above the plane of the epidermis and koilocytes in the stratum granulosum. 60 In comparison to the “firm” appearance of CVC, clinically, GCA has a “soft” appearance, and pathologically, it shows koilocytes in the stratum granulosum without any endophytic growth pattern.…”