Verrucous carcinoma is a rare and distinct subtype of squamous cell carcinoma (SCC), which is a type of skin cancer. Verrucous carcinoma primarily affects the mucous membranes, such as the oral cavity, genital area, and the soles of the feet.
Verrucous carcinoma is characterized by its warty or cauliflower-like appearance. It typically presents as a slow-growing, well-differentiated tumor that often resembles a benign wart. This characteristic appearance can sometimes make it difficult to distinguish from benign growths.
Epidemiology
Verrucous carcinoma is a relatively rare malignancy, accounting for a small percentage of all oral cancers.
The most significant risk factor for oral verrucous carcinoma is long-term tobacco use, including both smoking and smokeless forms of tobacco. Poor oral hygiene and chronic irritation, such as from ill-fitting dentures or sharp teeth, are also associated risk factors.
The incidence of oral verrucous carcinoma can vary geographically, with higher rates reported in regions with a high prevalence of tobacco use.
Genital verrucous carcinoma is even rarer than its oral counterpart and accounts for a small fraction of all genital cancers. It typically affects older individuals, like oral verrucous carcinoma, and has a slight male predominance.
Anatomy
Pathophysiology
Chronic irritation or inflammation is often a triggering factor in the development of verrucous carcinoma. In the oral cavity, this irritation can result from long-term tobacco use, poor oral hygiene, sharp teeth, or ill-fitting dentures.
In the genital area, infection with high-risk strains of human papillomavirus (HPV) is a significant risk factor. Chronic irritation can lead to cellular damage and genetic mutations, setting the stage for carcinogenesis.
The cancer cells in verrucous carcinoma are well-differentiated, meaning they closely resemble normal squamous epithelial cells.
Unlike typical squamous cell carcinomas, verrucous carcinoma cells exhibit minimal cellular atypia (abnormalities), which contributes to their slow growth. Verrucous carcinoma cells tend to grow outward in a warty or papillary fashion, forming a raised, cauliflower-like mass.
Etiology
Persistent and chronic irritation or trauma to the affected tissue is considered a significant contributing factor for verrucous carcinoma. This chronic irritation can lead to cellular damage and inflammation, which, over time, may promote the development of cancer.
In cases of genital verrucous carcinoma, infection with high-risk strains of human papillomavirus (HPV), particularly HPV types 16 and 18, has been implicated as a risk factor. These high-risk HPV types are known to increase the risk of various cancers, including cervical cancer and certain types of head and neck cancer.
Long-term tobacco use, especially chewing tobacco or betel quid, can irritate the mucous membranes. Friction from sexual activity, poor hygiene, and chronic inflammation are potential sources of irritation.
Genetics
Prognostic Factors
The anatomical site where verrucous carcinoma occurs can impact the prognosis. Tumors located in the buccal mucosa or gingiva tend to have a better prognosis than those in the posterior oral cavity or throat, where they may be more challenging to treat surgically.
While verrucous carcinoma tends to grow superficially, its depth of invasion into surrounding tissues can impact the prognosis. Superficial lesions are easier to treat successfully, while deeper invasion may lead to more aggressive treatment and a higher risk of complications.
The specific location within the genital area may affect prognosis. Lesions on the external genitalia are often more accessible for surgical treatment than those in deeper regions.
Clinical History
Physical Examination
The healthcare provider will examine the oral cavity, including the lips, tongue, gums, buccal mucosa, palate, and floor of the mouth, to identify any abnormal growths or lesions.
They will examine the lesion for its size, shape, color, and texture. Oral verrucous carcinoma typically presents as a slow-growing, raised, warty or cauliflower-like growth.
Patients may report any pain, discomfort, or changes in sensation associated with the lesion. The provider may also examine the regional lymph nodes in the neck to check for any enlargement or tenderness, as lymph node involvement can occur in advanced cases.
Age group
Associated comorbidity
The most significant risk factor for oral verrucous carcinoma is long-term tobacco use, including smoking and smokeless forms of tobacco like chewing tobacco and snuff.
Chronic alcohol consumption, especially when combined with tobacco use, can increase the risk of oral cancers, including verrucous carcinoma.
Inadequate oral hygiene practices, leading to gum disease, tooth decay, and chronic irritation, can contribute to the development of oral verrucous carcinoma.
Associated activity
Acuity of presentation
Oral verrucous carcinoma often presents with a relatively low level of acuity. It tends to develop slowly over a period of several months to years.
Patients with oral verrucous carcinoma may initially notice non-specific symptoms, such as a persistent lump, thickening, or wart-like growth on the inner cheek, gum, or other parts of the oral cavity. These lesions are usually painless and may resemble benign growths, which can lead to delayed diagnosis.
Due to its slow growth and lack of early symptoms, oral verrucous carcinoma is often diagnosed at an advanced stage when it has become more extensive.
Differential Diagnoses
Verruca Warts: Warts caused by human papillomavirus (HPV) can resemble oral verrucous carcinoma, especially when they grow on the mucous membranes.
Leukoplakia: Leukoplakia is a white, thickened patch that can occur on the mucous membranes of the oral cavity. While it is not cancerous by itself, it can be a precursor to oral cancer, including verrucous carcinoma.
Squamous Cell Carcinoma: Traditional squamous cell carcinoma can sometimes appear like verrucous carcinoma in its early stages.
Lichen Sclerosus: Lichen sclerosus is a chronic skin condition that can affect the genital area and cause white, thin, and wrinkled patches.
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Surgical Excision: Surgical excision is the primary treatment for verrucous carcinoma. The goal is to completely remove the tumor with clear margins to minimize the risk of recurrence.
Lymph Node Evaluation: In cases where there is concern about lymph node involvement, such as in advanced or high-risk tumors, sentinel lymph node biopsy or more extensive lymph node dissection may be performed to assess whether the cancer has spread to regional lymph nodes.
Radiation Therapy: While verrucous carcinoma is typically less aggressive and less likely to metastasize compared to other cancers, adjuvant radiation therapy may be considered in certain situations.
This includes cases with positive margins after surgery, extensive local disease, or regional lymph node involvement.
Follow-Up: Patients who have undergone treatment for verrucous carcinoma require regular follow-up and surveillance to monitor for any signs of recurrence or metastasis.
Supportive Care and Management: Palliative care and supportive care services may be provided to manage symptoms, improve quality of life, and provide emotional support to patients and their families.
Tobacco Cessation: If tobacco use is a risk factor, quitting smoking and tobacco products is one of the most critical environmental modifications. Tobacco is a known carcinogen and is strongly associated with oral verrucous carcinoma.
Oral Hygiene: Maintaining good oral hygiene practices can help prevent oral verrucous carcinoma. Regular dental check-ups, proper brushing and flossing, and the treatment of gum disease or dental issues are essential.
Foot Care: For individuals at risk of plantar verrucous carcinoma, proper foot care is important. This includes wearing comfortable shoes, avoiding excessive friction or pressure on the soles of the feet, and promptly addressing any foot injuries or lesions.
Occupational Safety: Occupational exposures to carcinogens or irritants may contribute to verrucous carcinoma. Ensuring proper workplace safety measures and minimizing exposure to hazardous substances can reduce the risk.
Immune Health: Maintaining a healthy immune system can be important in preventing the development of verrucous carcinoma, particularly genital verrucous carcinoma, which can be associated with HPV infection.
Use of Adjuvant Chemotherapy in Verrucous Carcinoma
While chemotherapy is not usually the first-line treatment for verrucous carcinoma, it may be considered in certain situations, particularly when other treatments have not been successful, or when the cancer has recurred or metastasized.
In select cases with high-risk features, such as the presence of regional lymph node involvement or extensive local disease, adjuvant chemotherapy may be used after surgery or radiation therapy to reduce the risk of local recurrence.
Use of topical or systemic chemotherapy in Cutaneous Verrucous Carcinoma
Other treatments that have been used for cutaneous VC with variable success include topical or systemic chemotherapy (bleomycin, 5-fluorouracil, cisplatin, methotrexate), carbon-dioxide laser, intralesional interferon alfa, imiquimod, and photodynamic therapy.
Bleomycin: Bleomycin is an anticancer antibiotic that may be used in combination with other chemotherapy agents for the treatment of SCC. It works by causing DNA damage in cancer cells.
Cisplatin: Cisplatin is a chemotherapy drug that is sometimes used in the treatment of SCC. It works by damaging DNA in cancer cells, preventing their replication.
5-Fluorouracil (5-FU): 5-FU is another chemotherapy drug used in the treatment of SCC. It interferes with the synthesis of DNA and RNA in cancer cells, inhibiting their growth.
Methotrexate: Methotrexate is a chemotherapy drug that interferes with the growth of cancer cells by inhibiting DNA synthesis. It may be considered in certain cases.
Surgical Excision: Surgical excision is the main treatment for verrucous carcinoma. The goal is to remove the tumor along with a margin of healthy tissue to ensure complete removal.
Mohs Micrographic Surgery: Mohs surgery is a specialized technique used when complete removal is essential for tumors in cosmetically sensitive areas or those with uncertain margins.
Radiation Therapy: Adjuvant radiation therapy may be recommended in cases where the tumor is extensive, has involved deep tissues, or when positive margins are found after surgery.
Radiation therapy : involves delivering targeted radiation to the tumor bed to destroy any remaining cancer cells. It may be given externally or internally, depending on the situation.
use-of-phases-in-managing-verrucous-carcinoma
Diagnosis Phase: This includes a physical examination of the affected area, such as the oral cavity, genitalia, or soles of the feet.
Treatment Phase: The primary treatment for verrucous carcinoma is typically surgical excision with wide margins to ensure complete removal of the tumor.
Therapies such as radiation therapy or chemotherapy may be considered in certain cases, especially when there are concerns about positive margins, lymph node involvement, or extensive local disease.
Follow-Up and Surveillance Phase: Patients who have undergone treatment for verrucous carcinoma require regular follow-up and surveillance to monitor for any signs of recurrence or metastasis.
Medication
Future Trends
Media Gallary
References
Verrucous carcinoma: A clinicopathological study – PMC (nih.gov)
Verrucous carcinoma is a rare and distinct subtype of squamous cell carcinoma (SCC), which is a type of skin cancer. Verrucous carcinoma primarily affects the mucous membranes, such as the oral cavity, genital area, and the soles of the feet.
Verrucous carcinoma is characterized by its warty or cauliflower-like appearance. It typically presents as a slow-growing, well-differentiated tumor that often resembles a benign wart. This characteristic appearance can sometimes make it difficult to distinguish from benign growths.
Verrucous carcinoma is a relatively rare malignancy, accounting for a small percentage of all oral cancers.
The most significant risk factor for oral verrucous carcinoma is long-term tobacco use, including both smoking and smokeless forms of tobacco. Poor oral hygiene and chronic irritation, such as from ill-fitting dentures or sharp teeth, are also associated risk factors.
The incidence of oral verrucous carcinoma can vary geographically, with higher rates reported in regions with a high prevalence of tobacco use.
Genital verrucous carcinoma is even rarer than its oral counterpart and accounts for a small fraction of all genital cancers. It typically affects older individuals, like oral verrucous carcinoma, and has a slight male predominance.
Chronic irritation or inflammation is often a triggering factor in the development of verrucous carcinoma. In the oral cavity, this irritation can result from long-term tobacco use, poor oral hygiene, sharp teeth, or ill-fitting dentures.
In the genital area, infection with high-risk strains of human papillomavirus (HPV) is a significant risk factor. Chronic irritation can lead to cellular damage and genetic mutations, setting the stage for carcinogenesis.
The cancer cells in verrucous carcinoma are well-differentiated, meaning they closely resemble normal squamous epithelial cells.
Unlike typical squamous cell carcinomas, verrucous carcinoma cells exhibit minimal cellular atypia (abnormalities), which contributes to their slow growth. Verrucous carcinoma cells tend to grow outward in a warty or papillary fashion, forming a raised, cauliflower-like mass.
Persistent and chronic irritation or trauma to the affected tissue is considered a significant contributing factor for verrucous carcinoma. This chronic irritation can lead to cellular damage and inflammation, which, over time, may promote the development of cancer.
In cases of genital verrucous carcinoma, infection with high-risk strains of human papillomavirus (HPV), particularly HPV types 16 and 18, has been implicated as a risk factor. These high-risk HPV types are known to increase the risk of various cancers, including cervical cancer and certain types of head and neck cancer.
Long-term tobacco use, especially chewing tobacco or betel quid, can irritate the mucous membranes. Friction from sexual activity, poor hygiene, and chronic inflammation are potential sources of irritation.
The anatomical site where verrucous carcinoma occurs can impact the prognosis. Tumors located in the buccal mucosa or gingiva tend to have a better prognosis than those in the posterior oral cavity or throat, where they may be more challenging to treat surgically.
While verrucous carcinoma tends to grow superficially, its depth of invasion into surrounding tissues can impact the prognosis. Superficial lesions are easier to treat successfully, while deeper invasion may lead to more aggressive treatment and a higher risk of complications.
The specific location within the genital area may affect prognosis. Lesions on the external genitalia are often more accessible for surgical treatment than those in deeper regions.
The healthcare provider will examine the oral cavity, including the lips, tongue, gums, buccal mucosa, palate, and floor of the mouth, to identify any abnormal growths or lesions.
They will examine the lesion for its size, shape, color, and texture. Oral verrucous carcinoma typically presents as a slow-growing, raised, warty or cauliflower-like growth.
Patients may report any pain, discomfort, or changes in sensation associated with the lesion. The provider may also examine the regional lymph nodes in the neck to check for any enlargement or tenderness, as lymph node involvement can occur in advanced cases.
The most significant risk factor for oral verrucous carcinoma is long-term tobacco use, including smoking and smokeless forms of tobacco like chewing tobacco and snuff.
Chronic alcohol consumption, especially when combined with tobacco use, can increase the risk of oral cancers, including verrucous carcinoma.
Inadequate oral hygiene practices, leading to gum disease, tooth decay, and chronic irritation, can contribute to the development of oral verrucous carcinoma.
Oral verrucous carcinoma often presents with a relatively low level of acuity. It tends to develop slowly over a period of several months to years.
Patients with oral verrucous carcinoma may initially notice non-specific symptoms, such as a persistent lump, thickening, or wart-like growth on the inner cheek, gum, or other parts of the oral cavity. These lesions are usually painless and may resemble benign growths, which can lead to delayed diagnosis.
Due to its slow growth and lack of early symptoms, oral verrucous carcinoma is often diagnosed at an advanced stage when it has become more extensive.
Verruca Warts: Warts caused by human papillomavirus (HPV) can resemble oral verrucous carcinoma, especially when they grow on the mucous membranes.
Leukoplakia: Leukoplakia is a white, thickened patch that can occur on the mucous membranes of the oral cavity. While it is not cancerous by itself, it can be a precursor to oral cancer, including verrucous carcinoma.
Squamous Cell Carcinoma: Traditional squamous cell carcinoma can sometimes appear like verrucous carcinoma in its early stages.
Lichen Sclerosus: Lichen sclerosus is a chronic skin condition that can affect the genital area and cause white, thin, and wrinkled patches.
Surgical Excision: Surgical excision is the primary treatment for verrucous carcinoma. The goal is to completely remove the tumor with clear margins to minimize the risk of recurrence.
Lymph Node Evaluation: In cases where there is concern about lymph node involvement, such as in advanced or high-risk tumors, sentinel lymph node biopsy or more extensive lymph node dissection may be performed to assess whether the cancer has spread to regional lymph nodes.
Radiation Therapy: While verrucous carcinoma is typically less aggressive and less likely to metastasize compared to other cancers, adjuvant radiation therapy may be considered in certain situations.
This includes cases with positive margins after surgery, extensive local disease, or regional lymph node involvement.
Follow-Up: Patients who have undergone treatment for verrucous carcinoma require regular follow-up and surveillance to monitor for any signs of recurrence or metastasis.
Supportive Care and Management: Palliative care and supportive care services may be provided to manage symptoms, improve quality of life, and provide emotional support to patients and their families.
Dermatology, General
Tobacco Cessation: If tobacco use is a risk factor, quitting smoking and tobacco products is one of the most critical environmental modifications. Tobacco is a known carcinogen and is strongly associated with oral verrucous carcinoma.
Oral Hygiene: Maintaining good oral hygiene practices can help prevent oral verrucous carcinoma. Regular dental check-ups, proper brushing and flossing, and the treatment of gum disease or dental issues are essential.
Foot Care: For individuals at risk of plantar verrucous carcinoma, proper foot care is important. This includes wearing comfortable shoes, avoiding excessive friction or pressure on the soles of the feet, and promptly addressing any foot injuries or lesions.
Occupational Safety: Occupational exposures to carcinogens or irritants may contribute to verrucous carcinoma. Ensuring proper workplace safety measures and minimizing exposure to hazardous substances can reduce the risk.
Immune Health: Maintaining a healthy immune system can be important in preventing the development of verrucous carcinoma, particularly genital verrucous carcinoma, which can be associated with HPV infection.
Dermatology, General
While chemotherapy is not usually the first-line treatment for verrucous carcinoma, it may be considered in certain situations, particularly when other treatments have not been successful, or when the cancer has recurred or metastasized.
In select cases with high-risk features, such as the presence of regional lymph node involvement or extensive local disease, adjuvant chemotherapy may be used after surgery or radiation therapy to reduce the risk of local recurrence.
Dermatology, General
Other treatments that have been used for cutaneous VC with variable success include topical or systemic chemotherapy (bleomycin, 5-fluorouracil, cisplatin, methotrexate), carbon-dioxide laser, intralesional interferon alfa, imiquimod, and photodynamic therapy.
Bleomycin: Bleomycin is an anticancer antibiotic that may be used in combination with other chemotherapy agents for the treatment of SCC. It works by causing DNA damage in cancer cells.
Cisplatin: Cisplatin is a chemotherapy drug that is sometimes used in the treatment of SCC. It works by damaging DNA in cancer cells, preventing their replication.
5-Fluorouracil (5-FU): 5-FU is another chemotherapy drug used in the treatment of SCC. It interferes with the synthesis of DNA and RNA in cancer cells, inhibiting their growth.
Methotrexate: Methotrexate is a chemotherapy drug that interferes with the growth of cancer cells by inhibiting DNA synthesis. It may be considered in certain cases.
Dermatology, General
Surgical Excision: Surgical excision is the main treatment for verrucous carcinoma. The goal is to remove the tumor along with a margin of healthy tissue to ensure complete removal.
Mohs Micrographic Surgery: Mohs surgery is a specialized technique used when complete removal is essential for tumors in cosmetically sensitive areas or those with uncertain margins.
Radiation Therapy: Adjuvant radiation therapy may be recommended in cases where the tumor is extensive, has involved deep tissues, or when positive margins are found after surgery.
Radiation therapy : involves delivering targeted radiation to the tumor bed to destroy any remaining cancer cells. It may be given externally or internally, depending on the situation.
Dermatology, General
Diagnosis Phase: This includes a physical examination of the affected area, such as the oral cavity, genitalia, or soles of the feet.
Treatment Phase: The primary treatment for verrucous carcinoma is typically surgical excision with wide margins to ensure complete removal of the tumor.
Therapies such as radiation therapy or chemotherapy may be considered in certain cases, especially when there are concerns about positive margins, lymph node involvement, or extensive local disease.
Follow-Up and Surveillance Phase: Patients who have undergone treatment for verrucous carcinoma require regular follow-up and surveillance to monitor for any signs of recurrence or metastasis.
Verrucous carcinoma: A clinicopathological study – PMC (nih.gov)
Verrucous carcinoma is a rare and distinct subtype of squamous cell carcinoma (SCC), which is a type of skin cancer. Verrucous carcinoma primarily affects the mucous membranes, such as the oral cavity, genital area, and the soles of the feet.
Verrucous carcinoma is characterized by its warty or cauliflower-like appearance. It typically presents as a slow-growing, well-differentiated tumor that often resembles a benign wart. This characteristic appearance can sometimes make it difficult to distinguish from benign growths.
Verrucous carcinoma is a relatively rare malignancy, accounting for a small percentage of all oral cancers.
The most significant risk factor for oral verrucous carcinoma is long-term tobacco use, including both smoking and smokeless forms of tobacco. Poor oral hygiene and chronic irritation, such as from ill-fitting dentures or sharp teeth, are also associated risk factors.
The incidence of oral verrucous carcinoma can vary geographically, with higher rates reported in regions with a high prevalence of tobacco use.
Genital verrucous carcinoma is even rarer than its oral counterpart and accounts for a small fraction of all genital cancers. It typically affects older individuals, like oral verrucous carcinoma, and has a slight male predominance.
Chronic irritation or inflammation is often a triggering factor in the development of verrucous carcinoma. In the oral cavity, this irritation can result from long-term tobacco use, poor oral hygiene, sharp teeth, or ill-fitting dentures.
In the genital area, infection with high-risk strains of human papillomavirus (HPV) is a significant risk factor. Chronic irritation can lead to cellular damage and genetic mutations, setting the stage for carcinogenesis.
The cancer cells in verrucous carcinoma are well-differentiated, meaning they closely resemble normal squamous epithelial cells.
Unlike typical squamous cell carcinomas, verrucous carcinoma cells exhibit minimal cellular atypia (abnormalities), which contributes to their slow growth. Verrucous carcinoma cells tend to grow outward in a warty or papillary fashion, forming a raised, cauliflower-like mass.
Persistent and chronic irritation or trauma to the affected tissue is considered a significant contributing factor for verrucous carcinoma. This chronic irritation can lead to cellular damage and inflammation, which, over time, may promote the development of cancer.
In cases of genital verrucous carcinoma, infection with high-risk strains of human papillomavirus (HPV), particularly HPV types 16 and 18, has been implicated as a risk factor. These high-risk HPV types are known to increase the risk of various cancers, including cervical cancer and certain types of head and neck cancer.
Long-term tobacco use, especially chewing tobacco or betel quid, can irritate the mucous membranes. Friction from sexual activity, poor hygiene, and chronic inflammation are potential sources of irritation.
The anatomical site where verrucous carcinoma occurs can impact the prognosis. Tumors located in the buccal mucosa or gingiva tend to have a better prognosis than those in the posterior oral cavity or throat, where they may be more challenging to treat surgically.
While verrucous carcinoma tends to grow superficially, its depth of invasion into surrounding tissues can impact the prognosis. Superficial lesions are easier to treat successfully, while deeper invasion may lead to more aggressive treatment and a higher risk of complications.
The specific location within the genital area may affect prognosis. Lesions on the external genitalia are often more accessible for surgical treatment than those in deeper regions.
The healthcare provider will examine the oral cavity, including the lips, tongue, gums, buccal mucosa, palate, and floor of the mouth, to identify any abnormal growths or lesions.
They will examine the lesion for its size, shape, color, and texture. Oral verrucous carcinoma typically presents as a slow-growing, raised, warty or cauliflower-like growth.
Patients may report any pain, discomfort, or changes in sensation associated with the lesion. The provider may also examine the regional lymph nodes in the neck to check for any enlargement or tenderness, as lymph node involvement can occur in advanced cases.
The most significant risk factor for oral verrucous carcinoma is long-term tobacco use, including smoking and smokeless forms of tobacco like chewing tobacco and snuff.
Chronic alcohol consumption, especially when combined with tobacco use, can increase the risk of oral cancers, including verrucous carcinoma.
Inadequate oral hygiene practices, leading to gum disease, tooth decay, and chronic irritation, can contribute to the development of oral verrucous carcinoma.
Oral verrucous carcinoma often presents with a relatively low level of acuity. It tends to develop slowly over a period of several months to years.
Patients with oral verrucous carcinoma may initially notice non-specific symptoms, such as a persistent lump, thickening, or wart-like growth on the inner cheek, gum, or other parts of the oral cavity. These lesions are usually painless and may resemble benign growths, which can lead to delayed diagnosis.
Due to its slow growth and lack of early symptoms, oral verrucous carcinoma is often diagnosed at an advanced stage when it has become more extensive.
Verruca Warts: Warts caused by human papillomavirus (HPV) can resemble oral verrucous carcinoma, especially when they grow on the mucous membranes.
Leukoplakia: Leukoplakia is a white, thickened patch that can occur on the mucous membranes of the oral cavity. While it is not cancerous by itself, it can be a precursor to oral cancer, including verrucous carcinoma.
Squamous Cell Carcinoma: Traditional squamous cell carcinoma can sometimes appear like verrucous carcinoma in its early stages.
Lichen Sclerosus: Lichen sclerosus is a chronic skin condition that can affect the genital area and cause white, thin, and wrinkled patches.
Surgical Excision: Surgical excision is the primary treatment for verrucous carcinoma. The goal is to completely remove the tumor with clear margins to minimize the risk of recurrence.
Lymph Node Evaluation: In cases where there is concern about lymph node involvement, such as in advanced or high-risk tumors, sentinel lymph node biopsy or more extensive lymph node dissection may be performed to assess whether the cancer has spread to regional lymph nodes.
Radiation Therapy: While verrucous carcinoma is typically less aggressive and less likely to metastasize compared to other cancers, adjuvant radiation therapy may be considered in certain situations.
This includes cases with positive margins after surgery, extensive local disease, or regional lymph node involvement.
Follow-Up: Patients who have undergone treatment for verrucous carcinoma require regular follow-up and surveillance to monitor for any signs of recurrence or metastasis.
Supportive Care and Management: Palliative care and supportive care services may be provided to manage symptoms, improve quality of life, and provide emotional support to patients and their families.
Dermatology, General
Tobacco Cessation: If tobacco use is a risk factor, quitting smoking and tobacco products is one of the most critical environmental modifications. Tobacco is a known carcinogen and is strongly associated with oral verrucous carcinoma.
Oral Hygiene: Maintaining good oral hygiene practices can help prevent oral verrucous carcinoma. Regular dental check-ups, proper brushing and flossing, and the treatment of gum disease or dental issues are essential.
Foot Care: For individuals at risk of plantar verrucous carcinoma, proper foot care is important. This includes wearing comfortable shoes, avoiding excessive friction or pressure on the soles of the feet, and promptly addressing any foot injuries or lesions.
Occupational Safety: Occupational exposures to carcinogens or irritants may contribute to verrucous carcinoma. Ensuring proper workplace safety measures and minimizing exposure to hazardous substances can reduce the risk.
Immune Health: Maintaining a healthy immune system can be important in preventing the development of verrucous carcinoma, particularly genital verrucous carcinoma, which can be associated with HPV infection.
Dermatology, General
While chemotherapy is not usually the first-line treatment for verrucous carcinoma, it may be considered in certain situations, particularly when other treatments have not been successful, or when the cancer has recurred or metastasized.
In select cases with high-risk features, such as the presence of regional lymph node involvement or extensive local disease, adjuvant chemotherapy may be used after surgery or radiation therapy to reduce the risk of local recurrence.
Dermatology, General
Other treatments that have been used for cutaneous VC with variable success include topical or systemic chemotherapy (bleomycin, 5-fluorouracil, cisplatin, methotrexate), carbon-dioxide laser, intralesional interferon alfa, imiquimod, and photodynamic therapy.
Bleomycin: Bleomycin is an anticancer antibiotic that may be used in combination with other chemotherapy agents for the treatment of SCC. It works by causing DNA damage in cancer cells.
Cisplatin: Cisplatin is a chemotherapy drug that is sometimes used in the treatment of SCC. It works by damaging DNA in cancer cells, preventing their replication.
5-Fluorouracil (5-FU): 5-FU is another chemotherapy drug used in the treatment of SCC. It interferes with the synthesis of DNA and RNA in cancer cells, inhibiting their growth.
Methotrexate: Methotrexate is a chemotherapy drug that interferes with the growth of cancer cells by inhibiting DNA synthesis. It may be considered in certain cases.
Dermatology, General
Surgical Excision: Surgical excision is the main treatment for verrucous carcinoma. The goal is to remove the tumor along with a margin of healthy tissue to ensure complete removal.
Mohs Micrographic Surgery: Mohs surgery is a specialized technique used when complete removal is essential for tumors in cosmetically sensitive areas or those with uncertain margins.
Radiation Therapy: Adjuvant radiation therapy may be recommended in cases where the tumor is extensive, has involved deep tissues, or when positive margins are found after surgery.
Radiation therapy : involves delivering targeted radiation to the tumor bed to destroy any remaining cancer cells. It may be given externally or internally, depending on the situation.
Dermatology, General
Diagnosis Phase: This includes a physical examination of the affected area, such as the oral cavity, genitalia, or soles of the feet.
Treatment Phase: The primary treatment for verrucous carcinoma is typically surgical excision with wide margins to ensure complete removal of the tumor.
Therapies such as radiation therapy or chemotherapy may be considered in certain cases, especially when there are concerns about positive margins, lymph node involvement, or extensive local disease.
Follow-Up and Surveillance Phase: Patients who have undergone treatment for verrucous carcinoma require regular follow-up and surveillance to monitor for any signs of recurrence or metastasis.
Verrucous carcinoma: A clinicopathological study – PMC (nih.gov)
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