Oral Verrucous Carcinoma: A Study of 12 Cases

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Abstract

Objectives:

The purpose of this clinical study was to identify a clinical and histopathological relationship between verrucous hyperplasia, verrucous keratosis, and verrucous carcinoma.

Methods:

We evaluated 12 patients who had developed oral verrucous carcinoma in the past 10 years in a follow-up study. In this study, the diagnostic criteria included clinical and histopathological features of the lesions. Each lesion was examined by a single oral pathologist.

Results:

All the patients were diagnosed with verrucous carcinoma following excisional biopsy. One patient was diagnosed with verrucous hyperplasia and another with verrucous keratosis in their initial histological findings. Mandibular, posterior alveolar crest, and retromolar trigone were the most affected sites (41.6%), followed by the buccal mucosa (16.6%), the palate (16.6%), the floor of the mouth (16.6%), and the lip (8.3%). No patients had evidence of recurrence after treatment.

Conclusions:

Verrucous hyperplasia, verrucous keratosis, and verrucous carcinoma may not be distinguished clinically or may coexist, resulting in diagnostic difficulties. It should be kept in mind that verrucous hyperplasia may also develop from leukoplakic lesions, and it may transform into verrucous carcinoma or squamous-cell carcinoma, acting as a potential precancerous lesion.

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Most cited references 14

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The precancer risk of betel quid chewing, tobacco use and alcohol consumption in oral leukoplakia and oral submucous fibrosis in southern Taiwan

C. Lee, Y C Ko, H-L Huang … (2003)

In areas where the practise of betel quid chewing is widespread and the chewers also often smoke and drink alcohol, the relation between oral precancerous lesion and condition to the three habits is probably complex. To explore such association and their attributable effect on oral leukoplakia (OL) and oral submucous fibrosis (OSF), a gender–age-matched case–control study was conducted at Kaohsiung, southern Taiwan. This study included 219 patients with newly diagnosed and histologically confirmed OL or OSF, and 876 randomly selected community controls. All information was collected by a structured questionnaire through in-person interviews. A preponderance of younger patients had OSF, while a predominance of older patients had OL. Betel quid chewing was strongly associated with both these oral diseases, the attributable fraction of OL being 73.2% and of OSF 85.4%. While the heterogeneity in risk for areca nut chewing across the two diseases was not apparent, betel quid chewing patients with OSF experienced a higher risk at each exposure level of chewing duration, quantity and cumulative measure than those who had OL. Alcohol intake did not appear to be a risk factor. However, cigarette smoking had a significant contribution to the risk of OL, and modified the effect of chewing based on an additive interaction model. For the two oral premalignant diseases combined, 86.5% was attributable to chewing and smoking. Our results suggested that, although betel quid chewing was a major cause for both OL and OSF, its effect might be difference between the two diseases. Cigarette smoking has a modifying effect in the development of oral leukoplakia.

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Verrucous carcinoma of the oral cavity.

Deborah Ackerman (1948)

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Proliferative verrucous leukoplakia. A long-term study of thirty patients.

Terrah J Paul Olson, Robin Hansen, S. Silverman (1985)

Up to 6% of oral leukoplakia, a relatively common mucosal disease, can be expected to become malignant. This report describes a long-term study of 30 patients in whom a particular form of leukoplakia was identified and labeled proliferative verrucous leukoplakia (PVL), a disease of unknown origin, which exhibits a strong tendency to develop areas of carcinoma. PVL begins as a simple hyperkeratosis but tends to spread and become multifocal. PVL is slow-growing, persistent, and irreversible, and in time areas become exophytic, wartlike, and apparently resistant to all forms of therapy as recurrence is the rule. The disease was most commonly seen in elderly women and had been present for many years. Patients were followed for 1 to 20 years. Thirteen died of or with their disease, 14 were alive with PVL, and 3 were alive without PVL at last contact. PVL rarely regressed despite therapy. All patients who died had persistent or recurrent disease. PVL appears to constitute a continuum of hyperkeratotic disease, ranging from a simple hyperkeratosis at one end to invasive squamous cell carcinoma at the other. Microscopic findings are dependent upon the stage of the disease's development and the location and adequacy of the biopsy.

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Author and article information

Journal

Journal ID (nlm-ta): Eur J Dent

Journal ID (publisher-id): Eur J Dent

Title: European Journal of Dentistry

Publisher: Dental Investigations Society

ISSN (Print): 1305-7456

ISSN (Electronic): 1305-7464

Publication date (Print): April 2010

Volume: 4

Issue: 2

Pages: 202-207

Affiliations

[a ]Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Erciyes, Kayseri, Turkey.

[b ]Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Ondokuz Mayis, Samsun, Turkey.

[c ]Professor, Department of Pathology, Gulhane Military Medical Academy, Ankara, Turkey.

Author notes

Corresponding author: Dr. Emel Bulut, Ondokuz Mayis Universitesi, Dis Hekimligi Fakultesi, 55139 Kurupelit, Samsun, Turkey. Phone: +90 362 3121919-3289, Fax: +90 362 4576032, E-mail: euzun@ 123456omu.edu.tr

Article

Publisher ID: dent04_p0202

DOI: 10.1055/s-0039-1697831

PMC ID: 2853822

PubMed ID: 20396454

SO-VID: 163ef60c-a973-49d4-9252-354c92041f80

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