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{{Infobox_Disease
{{SI}}                                                                 
| Name          = {{PAGENAME}}
{{CMG}} {{AE}} {{MV}}
  | Image          =
   
| Caption        =
{{SK}} Ackerman tumor; Verrucous carcinoma of the skin
| DiseasesDB    =
   
| ICD10          =
==Overview==
  | ICD9          =
| ICDO          = M8051/3
| OMIM          =  
| MedlinePlus    =  
| MeshID        = D018289
}}
{{Verrucous carcinoma}}
'''For patient information, click [[Verrucous carcinoma (patient information)|here]]'''


{{CMG}}
'''Verrucous carcinoma''' (also known as "Snuff dipper's cancer") is rare subtype of [[squamous cell carcinoma]].<ref>Ridge JA, Glisson BS, Lango MN, et al. [http://www.cancernetwork.com/cancer-management-11/chapter04/article/10165/1402663 "Head and Neck Tumors"] in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) [http://www.cancernetwork.com/cancer-management-11/ Cancer Management: A Multidisciplinary Approach]. 11 ed. 2008.</ref>  Common causes of verrucous carcinoma, include: [[tobacco]] chewing, or using [[Snuff (tobacco)|snuff]] orally. Patients with oral verrucous carcinoma may be at greater risk of a second oral [[Squamous cell carcinoma in situ of skin|squamous cell carcinoma]]. Verrucous carcinoma may occur in various [[Head and neck cancer|head and neck]] locations, as well as in the [[genitalia]]. The [[oral cavity]] is the most common site of this tumor.<ref>Medina JE, Dichtel W, Luna MA. Verrucous-squamous carcinoma of the oral cavity: a clinicopathologic study of 104 cases. Arch Otolaryngol 1984;110:437-40</ref> Verrucous carcinoma is most commonly seen among male patients between 50 to 80 years, and the median age at diagnosis is 67 years.<ref>Tornes K, Bang G, Koppang HS, Pedweson KN. Oral verrucous carcinoma. Int J Oral Surg 1985;14:485-92</ref><ref>Koch BB, Trask DK, Hoffman HT, Karnell LH, Robinson RA, Zhen W, Menck HR. National survey of head and neck verrucous carcinoma. Cancer 2001;92:110-20</ref> The diagnostic criteria for verrucous carcinoma is biopsy and surgical excision must provide adequate specimens including the full thickness of the tumors and adjacent uninvolved [[mucosa]] for correct diagnosis.<ref>McDonald JS, Crissman JD, Gluckman JL. Verrucous Carcinoma of the oral cavity. Head Neck Surg 1982;5:22-8</ref>


{{SK}}:Snuff dipper's cancer; ackerman tumor.
==Historical Perspective==
*Verrucous carcinoma was first discovered by Lauren V. Ackerman, an American physician in 1948.


==Classification==
*Verrucous carcinoma may be classified into 5 subtypes:


==Clinical features==
:*[[Epithelioma]] cuniculatum (Ackerman tumor, carcinoma cuniculatum)
* age- usually over 60 yrs
:*Buschke–Löwenstein tumor ([[Giant condyloma acuminatum|giant condyloma]])
* sex- males are more prone
:*Oral florid [[papillomatosis]]
* site- gingiva, buccal mucosa, alveolar mucosa, hard palate, floor of the mouth, larynx, oesophagus, penis, vagina, scrotum.
:*Subungual [[keratoacanthoma]]
* clinical presentation-
:*Gottron's carcinoid [[papillomatosis]]
** It’s a slow growing, diffuse, exophytic lesion usually covered by Leukoplakik patches.
** Invasive lesions quickly invade bones
** It is rapidly become fixed with underlying periosteum and cause gradual destruction of jaw bone.
** Enlarged regional lymph nodes
** Lesion shows painful multiple rugae like folds and deep clefts between them.


==Differential diagnosis==
==Pathophysiology==
* Papillary hyperplasia
*Verrucous carcinoma is characterized as a well-differentiated squamous cell carcinoma with minimal [[metastatic]] potential.<ref name="not">Koch BB, Trask DK, Hoffman HT, Karnell LH, Robinson RA, Zhen W, Menck HR. National survey of head and neck verrucous carcinoma. Cancer 2001;92:110-20</ref>
* Verrucous leukoplakia
*The pathogenesis of verrucous carcinoma is not fully understood.<ref name="not">Koch BB, Trask DK, Hoffman HT, Karnell LH, Robinson RA, Zhen W, Menck HR. National survey of head and neck verrucous carcinoma. Cancer 2001;92:110-20</ref>
* Squamous cell carcinoma
*Different locations of verrucous carcinoma, include:<ref name="not">Koch BB, Trask DK, Hoffman HT, Karnell LH, Robinson RA, Zhen W, Menck HR. National survey of head and neck verrucous carcinoma. Cancer 2001;92:110-20</ref>


==Treatment==  
:*[[Gingiva]]
Surgical excision or laser therapy
:*[[Buccal mucosa]]
:*[[Alveolar]] mucosa
:*[[Hard palate]]
:*Floor of the mouth
:*[[Larynx]]
:*[[Esophagus]]
:*[[Penis]]
:*[[Vaginal|Vagina]]
:*[[Scrotum]]
*There are no genetic mutations associated with the development of verrucous carcinoma.
*On gross pathology, characteristic findings of verrucous carcinoma include:<ref name="pmid7372883">{{cite journal |vauthors=Klima M, Kurtis B, Jordan PH |title=Verrucous carcinoma of skin |journal=J. Cutan. Pathol. |volume=7 |issue=2 |pages=88–98 |year=1980 |pmid=7372883 |doi= |url=}}</ref>
:*Cauliflower-like, exophytic mass
*On microscopic histopathological analysis, characteristic findings of verrucous carcinoma include:<ref name="pmid7372883">{{cite journal |vauthors=Klima M, Kurtis B, Jordan PH |title=Verrucous carcinoma of skin |journal=J. Cutan. Pathol. |volume=7 |issue=2 |pages=88–98 |year=1980 |pmid=7372883 |doi= |url=}}</ref>
:*Exophytic growth
:*Well-differentiated
:*"Glassy" appearance
:*Pushing border - described "elephant feet"


==Sources==
==Causes==
*[http://www.emedicine.com/derm/topic452.htm  eMedicine.com article]
* Common causes of verrucous carcinoma, include:<ref name="pmid7822496">{{cite journal |vauthors=Schwartz RA |title=Verrucous carcinoma of the skin and mucosa |journal=J. Am. Acad. Dermatol. |volume=32 |issue=1 |pages=1–21; quiz 22–4 |year=1995 |pmid=7822496 |doi= |url=}}</ref>
*[http://www.maxillofacialcenter.com/BondBook/mucosa/verrucousca.html  Maxillofacial Center for Education & Research article]


{{Epithelial neoplasms}}
:*Use [[Snuff (tobacco)|snuff]] orally
:*[[Tobacco]] chewing
:*Chewing [[Betel nut|betel nuts]] (Taiwan)
:*[[Alcohol]] consumption


[[Category:Dermatology]]
==Differentiating  Verrucous Carcinoma from Other Diseases==
[[Category:Types of cancer]]
*Verrucous carcinoma must be differentiated from other diseases that cause [[Leukoplakia|leukoplakic]] patches, such as:<ref name="pmid7822496">{{cite journal |vauthors=Schwartz RA |title=Verrucous carcinoma of the skin and mucosa |journal=J. Am. Acad. Dermatol. |volume=32 |issue=1 |pages=1–21; quiz 22–4 |year=1995 |pmid=7822496 |doi= |url=}}</ref>
 
:*[[Keratoacanthoma]]
:*Giant verruca vulgaris
:*Nongenital [[warts]]
:*[[Pyoderma]] vegetans
 
==Epidemiology and Demographics==
*Verrucous carcinoma is very uncommon
===Age===
*Verrucous carcinoma is more commonly observed among patients aged 50 to 80 years old.
*Verrucous carcinoma is more commonly observed among middle-aged and elderly adults.<ref name="pmid7372883">{{cite journal |vauthors=Klima M, Kurtis B, Jordan PH |title=Verrucous carcinoma of skin |journal=J. Cutan. Pathol. |volume=7 |issue=2 |pages=88–98 |year=1980 |pmid=7372883 |doi= |url=}}</ref>
 
===Gender===
*Males are more commonly affected with verrucous carcinoma than females. 
===Race===
*Verrucous carcinoma usually affects individuals of the Asian race.<ref name="pmid7372883">{{cite journal |vauthors=Klima M, Kurtis B, Jordan PH |title=Verrucous carcinoma of skin |journal=J. Cutan. Pathol. |volume=7 |issue=2 |pages=88–98 |year=1980 |pmid=7372883 |doi= |url=}}</ref>
 
==Risk Factors==
*The most common risk factor in the development of verrucous carcinoma is [[human papillomavirus]] (HPV) infection. Other factors, such as [[schistosomiasis]] infections, are related to bladder verrucous carcinoma.<ref name="pmid7822496">{{cite journal |vauthors=Schwartz RA |title=Verrucous carcinoma of the skin and mucosa |journal=J. Am. Acad. Dermatol. |volume=32 |issue=1 |pages=1–21; quiz 22–4 |year=1995 |pmid=7822496 |doi= |url=}}</ref>
 
== Natural History, Complications and Prognosis==
*The majority of patients with verrucous carcinoma remain asymptomatic for years.
*Early clinical features include [[translucent]] patches with [[erythematous]] base, and [[pruritus]].
*If left untreated, patients with verrucous carcinoma may progress to develop [[malignant]] transformation.<ref name="pmid7822496">{{cite journal |vauthors=Schwartz RA |title=Verrucous carcinoma of the skin and mucosa |journal=J. Am. Acad. Dermatol. |volume=32 |issue=1 |pages=1–21; quiz 22–4 |year=1995 |pmid=7822496 |doi= |url=}}</ref>
*Common complications of verrucous carcinoma, include:
:*[[Metastasis]]
*Prognosis is generally good, and the 5-survival rate of patients with verrucous carcinoma is approximately 75-80%.<ref name="pmid7822496">{{cite journal |vauthors=Schwartz RA |title=Verrucous carcinoma of the skin and mucosa |journal=J. Am. Acad. Dermatol. |volume=32 |issue=1 |pages=1–21; quiz 22–4 |year=1995 |pmid=7822496 |doi= |url=}}</ref>
 
== Diagnosis ==
=== Symptoms ===
*Verrucous carcinoma is usually asymptomatic.
*Symptoms of verrucous carcinoma may include the following:<ref name="pmid7372883">{{cite journal |vauthors=Klima M, Kurtis B, Jordan PH |title=Verrucous carcinoma of skin |journal=J. Cutan. Pathol. |volume=7 |issue=2 |pages=88–98 |year=1980 |pmid=7372883 |doi= |url=}}</ref>
 
:*Painful [[lymphadenopathy]]
:*Non-healing [[scar]]
:*[[Pruritus]]
 
=== Physical Examination ===
*Patients with verrucous carcinoma usually appear [[malnourished]].
*Physical examination may be remarkable for:<ref name="pmid7372883">{{cite journal |vauthors=Klima M, Kurtis B, Jordan PH |title=Verrucous carcinoma of skin |journal=J. Cutan. Pathol. |volume=7 |issue=2 |pages=88–98 |year=1980 |pmid=7372883 |doi= |url=}}</ref>
 
:*Slow growing, diffuse, exophytic lesion
:*[[Leukoplakia|Leukoplakic]] patches
:*Enlarged regional [[lymph nodes]].
:*Painful multiple [[Rugae|rugae-like fold]]<nowiki/>s and deep [[clefts]].
====Gallery====
<gallery>
Image:Verrucous carcinoma01.jpg|Verrucous carcinoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Verrucous carcinoma02.jpg|Verrucous carcinoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
 
=== Laboratory Findings ===
*There are no specific laboratory findings associated with verrucous carcinoma.<ref name="pmid7822496">{{cite journal |vauthors=Schwartz RA |title=Verrucous carcinoma of the skin and mucosa |journal=J. Am. Acad. Dermatol. |volume=32 |issue=1 |pages=1–21; quiz 22–4 |year=1995 |pmid=7822496 |doi= |url=}}</ref>
 
===Imaging Findings===
*There are no specific imaging findings for verrucous carcinoma.
 
== Treatment ==
=== Medical Therapy ===
*The mainstay of therapy for verrucous carcinoma, may include:<ref name="pmid20396454">{{cite journal |vauthors=Alkan A, Bulut E, Gunhan O, Ozden B |title=Oral verrucous carcinoma: a study of 12 cases |journal=Eur J Dent |volume=4 |issue=2 |pages=202–7 |year=2010 |pmid=20396454 |pmc=2853822 |doi= |url=}}</ref>
:*[[Bleomycin]]
:*[[5-fluorouracil]]
:*[[Cisplatin]]
:*[[Methotrexate]]
 
=== Surgery ===
*Surgery is the mainstay of therapy for verrucous carcinoma.
*Complete surgical excision ([[Mohs surgery]]) is the most common approach to the treatment of verrucous carcinoma.<ref name="pmid7372883">{{cite journal |vauthors=Klima M, Kurtis B, Jordan PH |title=Verrucous carcinoma of skin |journal=J. Cutan. Pathol. |volume=7 |issue=2 |pages=88–98 |year=1980 |pmid=7372883 |doi= |url=}}</ref>
 
=== Prevention ===
*Primary preventive measures available for verrucous carcinoma, include:<ref name="pmid7372883">{{cite journal |vauthors=Klima M, Kurtis B, Jordan PH |title=Verrucous carcinoma of skin |journal=J. Cutan. Pathol. |volume=7 |issue=2 |pages=88–98 |year=1980 |pmid=7372883 |doi= |url=}}</ref>
 
:*Avoid chewing [[tobacco]]
 
*Once diagnosed and successfully treated, patients with verrucous carcinoma are followed-up every 3, or 12 months.
*Follow-up testing, include: regular skin examinations.
 
==References==
{{Reflist|2}}
[[Category: Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Oncology]]
 
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Latest revision as of 17:01, 26 September 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Synonyms and keywords: Ackerman tumor; Verrucous carcinoma of the skin

Overview

Verrucous carcinoma (also known as "Snuff dipper's cancer") is rare subtype of squamous cell carcinoma.[1] Common causes of verrucous carcinoma, include: tobacco chewing, or using snuff orally. Patients with oral verrucous carcinoma may be at greater risk of a second oral squamous cell carcinoma. Verrucous carcinoma may occur in various head and neck locations, as well as in the genitalia. The oral cavity is the most common site of this tumor.[2] Verrucous carcinoma is most commonly seen among male patients between 50 to 80 years, and the median age at diagnosis is 67 years.[3][4] The diagnostic criteria for verrucous carcinoma is biopsy and surgical excision must provide adequate specimens including the full thickness of the tumors and adjacent uninvolved mucosa for correct diagnosis.[5]

Historical Perspective

  • Verrucous carcinoma was first discovered by Lauren V. Ackerman, an American physician in 1948.

Classification

  • Verrucous carcinoma may be classified into 5 subtypes:

Pathophysiology

  • Verrucous carcinoma is characterized as a well-differentiated squamous cell carcinoma with minimal metastatic potential.[6]
  • The pathogenesis of verrucous carcinoma is not fully understood.[6]
  • Different locations of verrucous carcinoma, include:[6]
  • There are no genetic mutations associated with the development of verrucous carcinoma.
  • On gross pathology, characteristic findings of verrucous carcinoma include:[7]
  • Cauliflower-like, exophytic mass
  • On microscopic histopathological analysis, characteristic findings of verrucous carcinoma include:[7]
  • Exophytic growth
  • Well-differentiated
  • "Glassy" appearance
  • Pushing border - described "elephant feet"

Causes

  • Common causes of verrucous carcinoma, include:[8]

Differentiating Verrucous Carcinoma from Other Diseases

  • Verrucous carcinoma must be differentiated from other diseases that cause leukoplakic patches, such as:[8]

Epidemiology and Demographics

  • Verrucous carcinoma is very uncommon

Age

  • Verrucous carcinoma is more commonly observed among patients aged 50 to 80 years old.
  • Verrucous carcinoma is more commonly observed among middle-aged and elderly adults.[7]

Gender

  • Males are more commonly affected with verrucous carcinoma than females.

Race

  • Verrucous carcinoma usually affects individuals of the Asian race.[7]

Risk Factors

  • The most common risk factor in the development of verrucous carcinoma is human papillomavirus (HPV) infection. Other factors, such as schistosomiasis infections, are related to bladder verrucous carcinoma.[8]

Natural History, Complications and Prognosis

  • The majority of patients with verrucous carcinoma remain asymptomatic for years.
  • Early clinical features include translucent patches with erythematous base, and pruritus.
  • If left untreated, patients with verrucous carcinoma may progress to develop malignant transformation.[8]
  • Common complications of verrucous carcinoma, include:
  • Prognosis is generally good, and the 5-survival rate of patients with verrucous carcinoma is approximately 75-80%.[8]

Diagnosis

Symptoms

  • Verrucous carcinoma is usually asymptomatic.
  • Symptoms of verrucous carcinoma may include the following:[7]

Physical Examination

  • Patients with verrucous carcinoma usually appear malnourished.
  • Physical examination may be remarkable for:[7]

Gallery

Laboratory Findings

  • There are no specific laboratory findings associated with verrucous carcinoma.[8]

Imaging Findings

  • There are no specific imaging findings for verrucous carcinoma.

Treatment

Medical Therapy

  • The mainstay of therapy for verrucous carcinoma, may include:[10]

Surgery

  • Surgery is the mainstay of therapy for verrucous carcinoma.
  • Complete surgical excision (Mohs surgery) is the most common approach to the treatment of verrucous carcinoma.[7]

Prevention

  • Primary preventive measures available for verrucous carcinoma, include:[7]
  • Once diagnosed and successfully treated, patients with verrucous carcinoma are followed-up every 3, or 12 months.
  • Follow-up testing, include: regular skin examinations.

References

  1. ↑ Ridge JA, Glisson BS, Lango MN, et al. "Head and Neck Tumors" in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach. 11 ed. 2008.
  2. ↑ Medina JE, Dichtel W, Luna MA. Verrucous-squamous carcinoma of the oral cavity: a clinicopathologic study of 104 cases. Arch Otolaryngol 1984;110:437-40
  3. ↑ Tornes K, Bang G, Koppang HS, Pedweson KN. Oral verrucous carcinoma. Int J Oral Surg 1985;14:485-92
  4. ↑ Koch BB, Trask DK, Hoffman HT, Karnell LH, Robinson RA, Zhen W, Menck HR. National survey of head and neck verrucous carcinoma. Cancer 2001;92:110-20
  5. ↑ McDonald JS, Crissman JD, Gluckman JL. Verrucous Carcinoma of the oral cavity. Head Neck Surg 1982;5:22-8
  6. ↑ 6.0 6.1 6.2 Koch BB, Trask DK, Hoffman HT, Karnell LH, Robinson RA, Zhen W, Menck HR. National survey of head and neck verrucous carcinoma. Cancer 2001;92:110-20
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 Klima M, Kurtis B, Jordan PH (1980). "Verrucous carcinoma of skin". J. Cutan. Pathol. 7 (2): 88–98. PMID 7372883.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 Schwartz RA (1995). "Verrucous carcinoma of the skin and mucosa". J. Am. Acad. Dermatol. 32 (1): 1–21, quiz 22–4. PMID 7822496.
  9. ↑ 9.0 9.1 "Dermatology Atlas".
  10. ↑ Alkan A, Bulut E, Gunhan O, Ozden B (2010). "Oral verrucous carcinoma: a study of 12 cases". Eur J Dent. 4 (2): 202–7. PMC 2853822. PMID 20396454.
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