Verrucous Carcinoma Definition:
Verrucous Carcinoma is a diffuse papillary, non metastasizing, well differentiated malignant neoplasm of the oral epithelium.
- Tobacco Chewing
- Snuff dipping habits – Moistened smokeless tobacco
Age: Above 60 yrs
Sex: Males > Females
- Most common: Gingiva, alveloar mucosa and buccal mucosa
- Less common: Floor of the mouth
- Papillary hyperplasia
- Verrucous leukoplakia
- Squamous cell carcinoma
- Chronic hyperplastic candidiasis
- Clinicalls it appears as a slow growing, exphytic, papillary growth having a white pebbly surface.
- The surface fo the lesion is sometimes warty and it shows multiple rugae like folds with deep clefts in between.
- Number: Can be Single or multiple
- Leukoplakia may be seen
- Mostly exophytic type but few lesions may be invasive type, invading into the underlying bone.
- Lesions in the buccal mucosa are very extensive causing Pain and tenderness and dysphagia.
- Lesions in the gingiva and alveolar mucosa become rapidly fixed to the periosteum and cause gradual invasion and destruction of the jaw bone.
- regional lymph nodes are tender and
- enlarged due to secondary infection.
- Hyperplastic epithelium with papillary surface covered by thick layer of para keratin.
- Rete Ridges: Enlarged bulb like acanthotic invaginating into the underlying connective tissue. project into the underlying connective tissue at the same level called as “Pushing Margin”
Verrucous Carcinoma histology
- “Parakeratin plugging” is seen
- The malignant cells are well differentiated and usually show normal level of maturation
- Abnormal mitotic activity is found in these cells.
- Cytologic atypia is absent
- Epithelial Pearls and Microcysts are seen.
- Well demarcated borders.
- Intact basement membrane and underlying connective tissues shows intense inflamatory cell infiltrate.
Surgical Excision and Laser Therapy