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Verrucous carcinoma  

Verrucous carcinoma is a variant of squamous cell carcinoma characterized by a predominantly exophytic overgrowth of well-differentiated keratinizing epithelium having minimal atypia and with locally destructive pushing margins at its interface with underlying connective tissue . These tumours are characterized by slow-growing warty lesions with low metastatic potential . Involvement of the regional node is uncommon.

Histopathology:

Verrucous carcinoma has thick, heavily keratinised papillae and blunt, broad stromal invaginations of well-differentiated squamous cells with minimal cytologic atypia and rare mitosis. The tumour extends into the underlying stroma with broad pushing rather than infiltrating border. A dense lymphoplasmocytic response is common. One fifth of verrucous carcinoma contains a co-existing squamous cell carcinoma with a greater tendency to recur locally.

Treatment:

These lesions are treated with surgery, and the 5-year survival rate is 80–90%. The role of radiotherapy is controversial because of low responsiveness to it and the potential for anaplasic transformation. However, several authors have found similar radio-responsiveness compared to well-differentiated squamous cell carcinoma without any anaplastic transformation . Today, it is recommended that these tumours be treated like any other squamous cell carcinoma of the oral cavity.

Image	Caption
	Figure 1: Verrucous carcinoma right commissure. Note the exophytic growth with finger-like projections (arrows), extending to the right cheek in a patient with oral submucous fibrosis.
	Figure 2: Verrucous carcinoma of the lip. Note the extensive warty growth with fingerlike projections involving almost all of the lower lip.
	Figure 3: Verrucous carcinoma lower lip. Note a 3x3 cm verrucous growth in the lower lip in this 65–year-old woman who has been chewing betel quid for the past 45 yrs.
	Figure 4: An extensive verrucous carcinoma involving the entire tongue causing difficulty in closing the mouth.
	Figure 5: Verrucous carcinoma of the right buccal mucosa. Note the extensive verrucous growth extending from the commissure to the posterior aspect of right buccal mucosa.
	Figure 6: Verrucous carcinoma on the right buccal mucosa.
	Figure 7: Verrucous carcinoma of the left buccal mucosa extending to the adjacent part of the lower lip.