Verrucous Carcinoma of the Foot with Bone Invasion: A Case Report

Abstract

Verrucous carcinoma of the foot often affects deep structures such as tendons, muscles, or bones. A 74-year-old man presented with a foot lesion that had been diagnosed as a skin infection 7 years earlier. He was treated with multiple excisions and superficial biopsies associated with antibiotic therapy without success. In our department he underwent an aggressive and accurate debridement with marginal excision harvesting multiple biopsies. Pathological evaluation of tissue at the time of operation confirmed the diagnosis of verrucous carcinoma of the foot. Therefore, the patient underwent an amputation below knee, and there were no postoperative complications; the patient was able to walk with the aid of a prosthesis with no signs of recurrence. The lesion follows a chronic course evolving from a discrete focal lesion to a large fungating deeply penetrating mass often compromised by local infection. The slow growth and confusing early-stage appearances can lead to delays in diagnosis of 8 to 15 years causing the extracutaneous involvement that requires a leg amputation. Many patients are initially treated with many topical medications without success, and most tumors have been treated as recalcitrant warts or corns for some time, whereas the basic approach is surgical.

Recurrent verrucous carcinoma of the foot: A case report

“…When lesion occurs on the foot, it mostly occurs in the forefoot [3] . As the tumor grows, it invades locally and involves the plantar fascia or the destruction of the metatarsal bones [4] . DNA of HPV serotypes 6, 11, 16 and 18 have been identified in verrucous carcinoma specimens [5] .…”

Plantar Warts: Epidemiology, Pathophysiology, and Clinical Management

“…20 Such lesions, especially plantar warts, have also been noted to undergo dysplastic changes and lead to verrucous carcinoma. [46][47][48] Malignant lesions tend to be more painful, friable, and erythematous than benign lesions. 19…”

“…27 The overwhelming majority of plantar warts are histologically benign, with only rare instances of malignant transformation, such as verrucous carcinoma. 11,36,[46][47][48] Thus, plantar warts are usually diagnosed clinically. 43 In cases of diagnostic uncertainty or treatment resistance, biopsy with histopathologic evaluation may be indicated.…”

Verrucous carcinoma of foot at an unusual site: Lessons to be learnt

“…years. [ 3 ] Although it is a low grade variant of squamous cell carcinoma which never metastasizes, it is notorious to cause local infiltration and destruction of the local structures through its chronic course. [ 3 ] Metastasis from verrucous carcinoma has been reported only five times in literature, being lymph nodes in all and lung in one patient.…”