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Oral verrucous carcinoma: a diagnostic and therapeutic challenge

Nejc Kristofelc
Nejc Kristofelc
, 
Nina Zidar
Nina Zidar
 and 
Primoz Strojan
Primoz Strojan
   | Mar 22, 2023
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Article Category: review
Published Online: Mar 22, 2023
Page range: 1 - 11
DOI: https://doi.org/10.2478/raon-2023-0015
© 2023 Nejc Kristofelc, Nina Zidar, Primoz Strojan, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Verrucous carcinoma of the right buccal mucosa (clinical stage T2N0M0) in an 81-year-old male patient. He presented with a whitish exophytic tumour mass of the inner side of the right cheek and without suspicious lymph nodes on the neck. The lesion was noticed by the patient a month before initial examination, and it occasionally hurt, but he had no problems feeding. Due to associated diseases, he was treated with radiotherapy (55 Gy, 2.2 Gy/fraction) and concurrent intravenous chemotherapy (vinblastine 2 mg, day 1; methotrexate 50 mg, day 2; bleomycin 15 mg, days 2 and 3). The patient died of injury 5.5 years after completion of treatment for verrucous carcinoma with no evidence of malignant disease in oral cavity.
Verrucous carcinoma of the right buccal mucosa (clinical stage T2N0M0) in an 81-year-old male patient. He presented with a whitish exophytic tumour mass of the inner side of the right cheek and without suspicious lymph nodes on the neck. The lesion was noticed by the patient a month before initial examination, and it occasionally hurt, but he had no problems feeding. Due to associated diseases, he was treated with radiotherapy (55 Gy, 2.2 Gy/fraction) and concurrent intravenous chemotherapy (vinblastine 2 mg, day 1; methotrexate 50 mg, day 2; bleomycin 15 mg, days 2 and 3). The patient died of injury 5.5 years after completion of treatment for verrucous carcinoma with no evidence of malignant disease in oral cavity.

Figure 2

Histopathology images of oral verrucous lesions. Squamous cell papilloma (A) exophytic lesion, composed of finger-like projections, lined by non-keratinizing stratified squamous epithelium and a central connective tissue core. Verrucous hyperplasia (B) exophytic lesion, composed of hyperplastic keratinizing squamous epithelium with no invasion into the underlying stroma. Verrucous carcinoma (C) exophytic tumour, resembling verrucous hyperplasia, but with invasive growth, consisting of broad epithelial islands and processes, with no atypia, exhibiting a pushing-border into the underlying stroma.
Histopathology images of oral verrucous lesions. Squamous cell papilloma (A) exophytic lesion, composed of finger-like projections, lined by non-keratinizing stratified squamous epithelium and a central connective tissue core. Verrucous hyperplasia (B) exophytic lesion, composed of hyperplastic keratinizing squamous epithelium with no invasion into the underlying stroma. Verrucous carcinoma (C) exophytic tumour, resembling verrucous hyperplasia, but with invasive growth, consisting of broad epithelial islands and processes, with no atypia, exhibiting a pushing-border into the underlying stroma.

Primary radiotherapy in the treatment of oral verrucous carcinoma - review of the literature series

Authors and study year Number of patients Local control rate with primary radiotherapy (%) Surgical salvage Local control rate with primary radiotherapy and salvage surgery (%) Survival Follow-up time
Kraus 196674 and Perezmesa, 13 0 (0) 8/13 7 (53.8) N.S. N.S.
Memula 198075 et al, 32 19 (59.4) 6/13 25 (78.1) 5-year 31% DFS N.S.
Medina 198430 et al, 12 7 (58.3) 3/5 10 (83.3) N.S. At least 2 years
Nair 1988et 76 al, 50 22 (44) at 3 years 4/28 N.S. 3-year 44% DFS At least 3 years
Vidysagar et al, 199236 107 55 (51.4) (residual disease in 19 patients, recurrence in 33 patients) 20/52 N.S. 5-year DFS 49% Range 6–60 months
Jyothirmayi et al, 19978 42 16 (38.1) (residual disease in 10 patients, recurrence in 16 patients) 9/26 N.S. 5-year DFS 66% Median 56 months (range 7–110)
Koch 20013 et al, 33 N.S. N.S. N.S. 5-year 41.8% RSR N.S.

Primary surgery in the treatment of oral verrucous carcinoma - review of the literature series

Authors and study year Number patients of Local control (%) Survival Follow-up time
Kraus 196674 and Perezmesa, 64 55 (85.9) N.S. N.S.
Medina 198430 et al, 90 74 (82.2) N.S. At least 2 years
Jyothirmayi 19978 et al, 11 N.S. 5-year DFS 68% Median (range 56 7months –110)
Koch 20013 et al, 484 N.S. 5-year RSR 85.7% N.S.
Kang 200338 et al, 38 38 (100) at 3 years 3-year OSR 94.7% Median 37.5 13months –76) (range
Walvekar 200917 et al, 101 80 (79.2) 5-year DFS 77.6% Median (range 4.61 0.5–years 14.3)
Huang et al, 200967 39 38 (97.4) 5-year CSS 89.1% Median 90 months (range, 13–171)
Candau-Alvarez et al, 201468 13 12 (92.3) OSR 92.9% for a mean follow-up of 2 years Mean 24.8 months (range 6–53)
Franklyn et al, 201710 22 21 (95.5) (recurrence in a patient with hybrid OVC) N.S. Median 24 months
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