Oral cavity cancer - Verrucous carcinoma
8 May 2023
This essay discusses a distinctive variant of squamous cell carcinoma (carcinomas are a type of cancer) in the oral cavity (mouth) called verrucous carcinoma.
Verrucous means having a wart-like growth pattern or any similar appearing, raised growth on a surface. Some but not all verrucous lesions are related to human papillomavirus (HPV).
Verrucous carcinoma of the oral cavity has these features:
2 - 12% of all oral carcinomas.
More common in men, ages 50+.
Usually occurs in the tongue and surrounding areas.
Characterized by slow growing, cauliflower-like exophytic (i.e. raised from the surface) growth.
Risk factors include:
Leukoplakia (white patches), but white patches due to a yeast infection, chronic irritation or lichen planus are not premalignant.
Tobacco use, alcohol consumption, chewing areca nuts and diet deficiencies (Int J Oncol 2016;49:59)
Leukoplakia (white patch) on the inside of the check, a risk factor for oral cancer if other causes have been ruled out, such as a fungal infection or chronic irritation.
Verrucous carcinoma has some but not all of the typical features of cancer:
It is locally invasive, which means it spreads to adjacent tissue including bone.
It typically does NOT metastasize.
Its cells are relatively normal looking under the microscope.
In the mouth, it is white / tan, exophytic and papillary (finger-like projections) and may invade adjacent areas:
Images of verrucous carcinoma below courtesy of Molly Housley Smith, D.M.D.
Large, exophytic, pebbly mass within a background of multifocal white plaques.
Raised, pebbly/granular white mass on the lateral tongue.
An excised specimen has similar features: tan / white and exophytic.
At low power magnification, the surface is papillary with a broad, rounded interface with the underlying tissue.
High power magnification shows cells with “bland” features not typical for squamous cell carcinoma.
For comparison, the figure below of a typical squamous cell carcinoma of the oral cavity shows darkened (hyperchromatic) cells that are variable (pleomorphic) and have uniform pink areas (keratinization).
For verrucous carcinoma of the oral cavity, surgical excision with adequate margins (i.e. excising a border of normal tissue) is usually curative because these cancers do not typically metastasize.
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