Oral verrucous carcinoma treated with carbon dioxide laser

Abstract

EditorVerrucous carcinoma, first reported by Ackerman in 1948, 1 is a distinct variant of differentiated squamous cell carcinoma with low-grade malignancy, slow growth and no metastatic potential. The oral cavity is the most common site of this tumour. The ages range from 50 to 80 years with a male predominance. In 1960, Rock and Fisher 2 described a similar lesion, which they named oral florid papillomatosis. Clinically warty tumours with a grey-white, deeply cleaved surface are detected. Histology reveals a sharply circumscribed tumour, with marked papillomatosis and overlying hyperkeratosis. Broad bulbous acanthotic projections of epidermis may extend deep into the stroma. An associated dense inflammatory cell infiltrate is often present. As with other forms of verrucous carcinoma, little atypia is present in most cases. The association of carcinogen exposure with oral cancer has been reported. The sources of the carcinogens include tobacco, alcohol, marijuana or cigarette smoking and betel nuts. 3 A 76-year-old woman presented with a 30-year history of a vulgar penfigous treated with decreasing doses of meprednisone, actually with 4 mg. Three years later, she was diagnosed and surgically treated for a clear cell renal carcinoma and a tubulovillous adenoma of the colon with high grade dysplasia. She was also a cigarette smoker for 30 years. On physical examination, a 10 · 3 cm verrucous erythematous tumour with areas of leukoplaquia was present on the top gum. Two surgical biopsies were performed in different areas of the lesion (Fig. 1a). Histological examination showed and exophytic growth of keratinocytes. Hyperkeratosis and acanthosis were accompanied by a marked upward elongation of dermal papillae. At high-power magnifica-

Verrucous carcinoma (carcinoma cuniculatum) of the head and neck: what do we know now that we did not know a decade ago?

“…Carbon dioxide laser therapy is being explored in the treatment of head and neck verrucous carcinomas [23,24]. Although some patients treated by laser therapy have experienced local recurrences, this modality, like radiation therapy, seems as though it will prove to be an attractive alternative to surgery, at least in selected patients.…”