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Oral Florid Papillomatosis Workup

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jun 21, 2016
 

Laboratory Studies

Ultrastructural studies may be considered. Findings suggest a well-differentiated squamous cell carcinoma[48] and are similar to those of conventional squamous cell carcinomas. The findings include prominent microvilli, decreased tonofilaments, and underdeveloped desmosomes.

With oral verrucous carcinoma (VC), tissue typing for HPV may be beneficial, assuming it proves clinically useful to divide verrucous carcinomas on the basis of HPV infection.[49] In one series, HPV was identified with the polymerase chain reaction in 13 of 29 cases of laryngeal verrucous carcinoma.[24]

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Imaging Studies

The latest radiographic techniques, such as magnetic resonance imaging, should be used to define the extent of the tumor and to determine whether underlying bone or other structures are involved.

Computed tomography (CT) can be used to demonstrate the exact location and the extent of the tumor for preoperative staging and surgical planning. Dual-energy CT may be used to enhance assessment of tumor margins.[50]

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Histologic Findings

The typical microscopic section shows a well-differentiated typical squamous cell carcinoma with verrucous clinical morphology.[1]

Histologically, oral verrucous carcinoma shows exophytic and endophytic growth patterns.[1] Its massively hyperplastic and exophytic epidermis has marked hyperkeratosis, sometimes with parakeratosis. Its prominent granular layer has tumor cells that may be vacuolated, resembling and indistinguishable from the koilocytes of condylomata acuminata.

Verrucous carcinoma is characterized by blunt projections of well-differentiated epithelium supported by an edematous stroma, with chronic inflammatory cells of lymphohistiocytic origin at its infiltrating margins. These blunt tumor masses extend into the dermis and deeper structures, forming sinuses and keratin-filled cysts. Bulbous islands of benign-appearing epithelium may infiltrate the subcutaneous tissue. This deceptively benign quality is associated with a basement membrane adjacent to its basal epithelial layer despite the composition of infiltrating tumor islands.[25]

Rare areas of focal disruption of the basement membrane are noted in oral verrucous carcinomas. Thus, neither the presence nor the absence of a basement membrane is a reliable indicator of tumor behavior. Atypical mitotic figures, individual cell necrosis, dyskeratosis, and multinucleated keratinocytes are rarely, if ever, evident. Centripetal keratinization of individual keratinocyte islands may be seen, but horn pearls are not. Individual cell cytologic features are relatively benign, with minimal dysplasia. Individual cells may be large and have big nuclei and prominent nucleoli. Occasionally, giant nuclei and enlarged malpighian keratinocytes may be evident. Intracytoplasmic glycogen is scant in verrucous carcinoma, as compared with keratoacanthoma and pseudoepitheliomatous hyperplasia.

Some oral mucosal verrucous carcinomas may be associated with small foci of floridly malignant squamous cell carcinomas,[35, 51, 52] adjacent ordinary squamous cell carcinomas,[53] or regional node metastases.[53, 54] In one study,[51] 21 (20%) of 104 oral verrucous carcinomas had similar foci with less differentiation than that of the verrucous carcinoma. Such foci of dysplasia are associated with a doubled recurrence rate and a 10% incidence of lymph node metastases.[52] Therefore, careful sectioning to remove as much tumor as possible is indicated.

Radiation therapy has been implicated in the anaplastic transformation of some verrucous carcinomas,[54] although anaplastic transformation may represent a possible terminal event in the natural progression of verrucous carcinoma.[55] This phenomenon may be an example of a verrucous carcinoma undergoing programmed dedifferentiation to become a classic squamous cell carcinoma. The hybrid verrucous carcinoma–squamous cell carcinoma deserves careful scrutiny.

The extraoral expansion of a local tumor into the underlying cartilage and bone results in moderate dyskeratosis and numerous mitotic features as the bone is replaced by tumor. Acute and chronic inflammation and a granulation tissue reaction are also present. Tumor cells are usually not found in the blood vessels or the lymphatics; this finding is presumably correlated with the general absence of metastases in patients with mucosal verrucous carcinoma.

An ordinary squamous cell carcinoma may be a clinically silent verrucous carcinoma with histologic patterns reflecting its warty and exophytic surface. If clusters of poorly differentiated cells are present, the tumor is a conventional squamous cell carcinoma with a high malignant potential and a tendency to metastasize. However, typical verrucous carcinomas with foci of conventional squamous cell carcinoma, that is, the hybrid verrucous carcinoma–squamous cell carcinoma, may be troubling.

The distinction between verrucous carcinoma and a large and persistent verruca vulgaris may be difficult at both clinical examination and histologic examination. Verrucous carcinoma and verruca vulgaris both have the keratinocytic vacuolization that is said to be characteristic of viral warts.[56] Avoid obtaining only a small superficial skin biopsy specimen; larger specimens facilitate the correct diagnosis. Verrucous hyperplasia of the oral mucosa must also be considered; it is best evaluated in biopsy specimens obtained from the lesional margins.[57]

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Channing R Barnett, MD Staff Physician, Department of Dermatology, University of Medicine and Dentistry of New Jersey

Channing R Barnett, MD is a member of the following medical societies: Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Julie C Harper, MD Assistant Program Director, Assistant Professor, Department of Dermatology, University of Alabama at Birmingham

Julie C Harper, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Received honoraria from Stiefel for speaking and teaching; Received honoraria from Allergan for speaking and teaching; Received honoraria from Intendis for speaking and teaching; Received honoraria from Coria for speaking and teaching; Received honoraria from Sanofi-Aventis for speaking and teaching.

References
  1. Schwartz RA. Verrucous carcinoma of the skin and mucosa. J Am Acad Dermatol. 1995 Jan. 32(1):1-21; quiz 22-4. [Medline].

  2. Ackerman LV. Verrucous carcinoma of the oral cavity. Surgery. 1948 Apr. 23(4):670-8. [Medline].

  3. Akyol A, Anadolu R, Anadolu Y, Ekmekci P, Gurgey E, Akay N. Multifocal papillomavirus epithelial hyperplasia: successful treatment with CO2 laser therapy combined with interferon alpha-2b. Int J Dermatol. 2003 Sep. 42(9):733-5. [Medline].

  4. Kren O. Arzt L, Zieler K. Mundschleimhautaffektionen. Eine zusammenfassende Darste. 1934. 3: 941-976.

  5. Friedell HL, Rosenthal LM. The etiologic role of chewing tobacco in cancer of the mouth. Report of eight cases treated with radiation. J Am Med Assoc. 1941. 116:2130-2135.

  6. Biemond P, ten Kate FJ, van Blankenstein M. Esophageal verrucous carcinoma: histologically a low-grade malignancy but clinically a fatal disease. J Clin Gastroenterol. 1991 Feb. 13(1):102-7. [Medline].

  7. Diengdoh JV, Leeming RD, Shaw MD. Verrucous carcinoma of the base of the skull. Br J Neurosurg. 1990. 4(1):73-6. [Medline].

  8. Daoud A, Lannigan FJ, McGlashan JA, Keen CE, Bowdler DA. Verrucous carcinoma of the maxillary antrum. J Laryngol Otol. 1991 Aug. 105(8):696-9. [Medline].

  9. Letichevsky V, Talmon Y, Samet A, Cohen Y. [Verrucous carcinoma of the nose and maxillary sinus]. Harefuah. 2001 Aug. 140(8):706-8, 806. [Medline].

  10. Kraus FT, Perezmesa C. Verrucous carcinoma. Clinical and pathologic study of 105 cases involving oral cavity, larynx and genitalia. Cancer. 1966 Jan. 19(1):26-38. [Medline].

  11. Schwade JG, Wara WM, Dedo HH, Phillips TL. Radiotherapy for verrucous carcinoma. Radiology. 1976 Sep. 120(3):677-9. [Medline].

  12. Elliott GB, Macdougall JA, Elliott JD. Problems of verrucose squamous carcinoma. Ann Surg. 1973 Jan. 177(1):21-9. [Medline].

  13. Rosai J. Lauren V. Ackerman, M.D. Am J Surg Pathol. 1994 Feb. 18(2):211-3. [Medline].

  14. Rock JA, Fisher ER. Florid papillomatosis of the oral cavity and larynx. Arch Otolaryngol. 1960 Nov. 72:593-8. [Medline].

  15. Wechsler HL, Fischer ER. Oral florid papillomatosis. Clinical, pathological and electron microscopic observations. Arch Dermatol. 1962 Oct. 86:480-92. [Medline].

  16. Angadi PV, Krishnapillai R. Cyclin D1 expression in oral squamous cell carcinoma and verrucous carcinoma: correlation with histological differentiation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Mar. 103(3):e30-5. [Medline].

  17. Patil GB, Hallikeri KS, Balappanavar AY, Hongal SG, Sanjaya PR, Sagari SG. Cyclin B1 overexpression in conventional oral squamous cell carcinoma and verrucous carcinoma- A correlation with clinicopathological features. Med Oral Patol Oral Cir Bucal. 2013 Jul 1. 18(4):e585-90. [Medline]. [Full Text].

  18. Stokes A, Guerra E, Bible J, Halligan E, Orchard G, Odell E, et al. Human papillomavirus detection in dysplastic and malignant oral verrucous lesions. J Clin Pathol. 2012 Mar. 65(3):283-6. [Medline].

  19. Hashemipour MA, Gholampour F, Fatah F, Bazregari S. Snus (nass) and oral cancer: A case series report. Dent Res J (Isfahan). 2013 Jan. 10(1):116-21. [Medline]. [Full Text].

  20. Sonalika WG, Anand T. Oral verrucous carcinoma: A retrospective analysis for clinicopathologic features. J Cancer Res Ther. 2016 Jan-Mar. 12 (1):142-5. [Medline].

  21. Bouquot JE. Oral verrucous carcinoma. Incidence in two US populations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Sep. 86(3):318-24. [Medline].

  22. Rajendran R, Sugathan CK, Augustine J, Vasudevan DM, Vijayakumar T. Ackerman's tumour (Verrucous carcinoma) of the oral cavity: a histopathologic study of 426 cases. Singapore Dent J. 1989 Dec. 14(1):48-53. [Medline].

  23. Vidyasagar MS, Fernandes DJ, Kasturi DP, et al. Radiotherapy and verrucous carcinoma of the oral cavity. A study of 107 cases. Acta Oncol. 1992. 31(1):43-7. [Medline].

  24. Fliss DM, Noble-Topham SE, McLachlin M, et al. Laryngeal verrucous carcinoma: a clinicopathologic study and detection of human papillomavirus using polymerase chain reaction. Laryngoscope. 1994 Feb. 104(2):146-52. [Medline].

  25. Kamath VV, Varma RR, Gadewar DR, Muralidhar M. Oral verrucous carcinoma. An analysis of 37 cases. J Craniomaxillofac Surg. 1989 Oct. 17(7):309-14. [Medline].

  26. Sllamniku B, Bauer W, Painter C, Sessions D. Clinical and histopathological considerations for the diagnosis and treatment of verrucous carcinoma of the larynx. Arch Otorhinolaryngol. 1989. 246(3):126-32. [Medline].

  27. Ferlito A, Recher G. Ackerman's tumor (verrucous carcinoma) of the larynx: a clinicopathologic study of 77 cases. Cancer. 1980 Oct 1. 46(7):1617-30. [Medline].

  28. McCoy JM, Waldron CA. Verrucous carcinoma of the oral cavity. A review of forty-nine cases. Oral Surg Oral Med Oral Pathol. 1981 Dec. 52(6):623-9. [Medline].

  29. Koch BB, Trask DK, Hoffman HT, et al. National survey of head and neck verrucous carcinoma: patterns of presentation, care, and outcome. Cancer. 2001 Jul 1. 92(1):110-20. [Medline].

  30. Agrawal R, Martin FW. Unusual presentation of verrucous carcinoma of maxillary antrum. J Otolaryngol. 1992 Oct. 21(5):371-2. [Medline].

  31. Peng Q, Wang Y, Quan H, Li Y, Tang Z. Oral verrucous carcinoma: From multifactorial etiology to diverse treatment regimens (Review). Int J Oncol. 2016 Jul. 49 (1):59-73. [Medline].

  32. Wenzel K, Saka B, Zimmermann R, Gundlach KK, Barten M, Gross G. Malignant conversion of florid oral and labial papillomatosis during topical immunotherapy with imiquimod. Med Microbiol Immunol. 2003 Aug. 192(3):161-4. [Medline].

  33. Pérez-Belmonte LM, Gómez-Moyano E, Herrero-Lifona L, Jiménez-Oñate F. [Verrocous mass on the tongue: oral florid papillomatosis]. Enferm Infecc Microbiol Clin. 2015 Feb. 33 (2):135-6. [Medline].

  34. Barnett JG, Hyman AB. Society Transactions. New York Academy of Medicine Jan 3, 1967. Oral florid verrucosis. Arch Dermatol. 1968. 97:479-481.

  35. Shroyer KR, Greer RO, Fankhouser CA, McGuirt WF, Marshall R. Detection of human papillomavirus DNA in oral verrucous carcinoma by polymerase chain reaction. Mod Pathol. 1993 Nov. 6(6):669-72. [Medline].

  36. Crook T, Tidy JA, Vousden KH. Degradation of p53 can be targeted by HPV E6 sequences distinct from those required for p53 binding and trans-activation. Cell. 1991 Nov 1. 67(3):547-56. [Medline].

  37. Scheffner M, Werness BA, Huibregtse JM, Levine AJ, Howley PM. The E6 oncoprotein encoded by human papillomavirus types 16 and 18 promotes the degradation of p53. Cell. 1990 Dec 21. 63(6):1129-36. [Medline].

  38. Sang BC, Barbosa MS. Single amino acid substitutions in "low-risk" human papillomavirus (HPV) type 6 E7 protein enhance features characteristic of the "high-risk" HPV E7 oncoproteins. Proc Natl Acad Sci U S A. 1992 Sep 1. 89(17):8063-7. [Medline].

  39. Sundström B, Mörnstad H, Axell T. Oral carcinomas associated with snuff dipping. Some clinical and histological characteristics of 23 tumours in Swedish males. J Oral Pathol. 1982 Jun. 11(3):245-51. [Medline].

  40. Simarak S, de Jong UW, Breslow N, et al. Cancer of the oral cavity, pharynx/larynx and lung in North Thailand: case-control study and analysis of cigar smoke. Br J Cancer. 1977 Jul. 36(1):130-40. [Medline].

  41. Alkan A, Bulut E, Gunhan O, Ozden B. Oral verrucous carcinoma: a study of 12 cases. Eur J Dent. 2010 Apr. 4(2):202-7. [Medline]. [Full Text].

  42. Agrawal R, Chauhan A, Kumar P. Spectrum of Oral Lesions in A Tertiary Care Hospital. J Clin Diagn Res. 2015 Jun. 9 (6):EC11-3. [Medline].

  43. Gokavarapu S, Chandrasekhara Rao LM, Patnaik SC, Parvataneni N, Raju KV, Chander R, et al. Reliability of Incision Biopsy for Diagnosis of Oral Verrucous Carcinoma: A Multivariate Clinicopathological Study. J Maxillofac Oral Surg. 2015 Sep. 14 (3):599-604. [Medline].

  44. Gandolfo S, Castellani R, Pentenero M. Proliferative verrucous leukoplakia: a potentially malignant disorder involving periodontal sites. J Periodontol. 2009 Feb. 80(2):274-81. [Medline].

  45. Mete O, Keskin Y, Hafiz G, Kayhan KB, Unur M. Oral proliferative verrucous leukoplakia: Underdiagnosed oral precursor lesion that requires retrospective clinicopathological correlation. Dermatol Online J. 2010 May 15. 16(5):6. [Medline].

  46. Gouvea AF, Moreira AE, Reis RR, Almeida OP, Lopes MA. Proliferative verrucous leukoplakia, squamous cell carcinoma and axillary metastasis. Med Oral Patol Oral Cir Bucal. 2010 Feb 21. [Medline].

  47. Pentenero M, Meleti M, Vescovi P, Gandolfo S. Oral proliferative verrucous leucoplakia: are there particular features for such an ambiguous entity? A systematic review. Br J Dermatol. 2014 May. 170(5):1039-47. [Medline].

  48. Prioleau PG, Santa Cruz DJ, Meyer JS, Bauer WC. Verrucous carcinoma: a light and electron microscopic, autoradiographic, and immunofluorescence study. Cancer. 1980 Jun 1. 45(11):2849-57. [Medline].

  49. Pilotti S, Donghi R, D'Amato L, et al. HPV detection and p53 alteration in squamous cell verrucous malignancies of the lower genital tract. Diagn Mol Pathol. 1993 Dec. 2(4):248-56. [Medline].

  50. Toepker M, Czerny C, Ringl H, Fruehwald-Pallamar J, Wolf F, Weber M, et al. Can dual-energy CT improve the assessment of tumor margins in oral cancer?. Oral Oncol. 2014 Mar. 50(3):221-7. [Medline].

  51. Medina JE, Dichtel W, Luna MA. Verrucous-squamous carcinomas of the oral cavity. A clinicopathologic study of 104 cases. Arch Otolaryngol. 1984 Jul. 110(7):437-40. [Medline].

  52. Luna MA, Tortoledo E, Medina JE. Verrucous carcinoma and "hybrid" verrucous-squamous carcinoma of oral cavity: a clinicopathologic study of 104 cases. Am J Clin Pathol. 1984. 81:803-804.

  53. Perez CA, Kraus FT, Evans JC, Powers WE. Anaplastic transformation in verrucous carcinoma of the oral cavity after radiation therapy. Radiology. 1966 Jan. 86(1):108-15. [Medline].

  54. McDonald JS, Crissman JD, Gluckman JL. Verrucous carcinoma of the oral cavity. Head Neck Surg. 1982 Sep-Oct. 5(1):22-8. [Medline].

  55. Memula N, Ridenhour G, Doss LL. Radiotherapeutic management of oral cavity verrucous carcinoma. Internat J Radiation Oncol Biol Phys. 1980. 6:1404.

  56. Fechner RE, Mills SE. Verruca vulgaris of the larynx: a distinctive lesion of probable viral origin confused with verrucous carcinoma. Am J Surg Pathol. 1982 Jun. 6(4):357-62. [Medline].

  57. Shear M, Pindborg JJ. Verrucous hyperplasia of the oral mucosa. Cancer. 1980 Oct 15. 46(8):1855-62. [Medline].

  58. Niparko JK, Rubinstein MI, McClatchey KD. Invasive squamous cell carcinoma within verrucous carcinoma. J Otolaryngol. 1988 Feb. 17(1):38-40. [Medline].

  59. Jyothirmayi R, Sankaranarayanan R, Varghese C, Jacob R, Nair MK. Radiotherapy in the treatment of verrucous carcinoma of the oral cavity. Oral Oncol. 1997 Mar. 33(2):124-8. [Medline].

  60. Strojan P, Soba E, Budihna M, Auersperg M. Radiochemotherapy with Vinblastine, Methotrexate, and Bleomycin in the treatment of verrucous carcinoma of the head and neck. J Surg Oncol. 2005 Dec 15. 92(4):278-83. [Medline].

  61. Fonts EA, Greenlaw RH, Rush BF, Rovin S. Verrucous squamous cell carcinoma of the oral cavity. Cancer. 1969 Jan. 23(1):152-60. [Medline].

  62. Proffitt SD, Spooner TR, Kosek JC. Origin of undifferentiated neoplasm from verrucous epidermal carcinoma of oral cavity following irradiation. Cancer. 1970 Aug. 26(2):389-93. [Medline].

  63. Van Nostrand AW, Olofsson J. Verrucous carcinoma of the larynx. A clinical and pathologic study of 10 cases. Cancer. 1972 Sep. 30(3):691-702. [Medline].

  64. Umebayashi Y, Uyeno K, Tsujii H, Otsuka F. Proton radiotherapy of skin carcinomas. Br J Dermatol. 1994 Jan. 130(1):88-91. [Medline].

  65. Smith RR, Kuhajda FP, Harris AE. Anaplastic transformation of verrucous carcinoma following radiotherapy. Am J Otolaryngol. 1985 Nov-Dec. 6(6):448-52. [Medline].

  66. Edström S, Johansson SL, Lindström J, Sandin I. Verrucous squamous cell carcinoma of the larynx: evidence for increased metastatic potential after irradiation. Otolaryngol Head Neck Surg. 1987 Oct. 97(4):381-4. [Medline].

  67. Goethals PL, Harrison EG Jr, Devine KD. Verrucous squamous carcinoma of the oral cavity. Am J Surg. 1963 Nov. 106:845-51. [Medline].

  68. Chen HM, Chen CT, Yang H, et al. Successful treatment of an extensive verrucous carcinoma with topical 5-aminolevulinic acid-mediated photodynamic therapy. J Oral Pathol Med. 2005 Apr. 34(4):253-6. [Medline].

  69. Lu YG, Wu JJ, Lei X, et al. Treatment of oral florid papillomatosis with systemic administration of photocarcinorin: an effective photodynamic therapy. Photomed Laser Surg. 2010 Dec. 28(6):831-3. [Medline].

  70. Tsuji T. Bleomycin iontophoretic therapy for verrucous carcinoma. Arch Dermatol. 1991 Jul. 127(7):973-5. [Medline].

  71. Hagedorn M, Weigel K, Petres J. Treatment of oral florid papillomatosis with bleomycin. Use of Holter catheter for intra-arterial administration. Arch Dermatol. 1978 Jul. 114(7):1083-4. [Medline].

  72. Kanee B. Oral florid papillomatosis complicated by verrucous squamous carcinoma. Treatment with methotrexate. Arch Dermatol. 1969 Feb. 99(2):196-202. [Medline].

  73. Wu CF, Chen CM, Shen YS, et al. Effective eradication of oral verrucous carcinoma with continuous intraarterial infusion chemotherapy. Head Neck. 2008 May. 30(5):611-7. [Medline].

  74. Lowy DR, Kirnbauer R, Schiller JT. Genital human papillomavirus infection. Proc Natl Acad Sci U S A. 1994 Mar 29. 91(7):2436-40. [Medline].

  75. Florin EH, Kolbusz RV, Goldberg LH. Verrucous carcinoma of the lip originating on the vermilion border. Int J Dermatol. 1994 Sep. 33(9):637. [Medline].

  76. Mohs FE, Sahl WJ. Chemosurgery for verrucous carcinoma. J Dermatol Surg Oncol. 1979 Apr. 5(4):302-6. [Medline].

  77. Pomatto E, Bocca M, Carbone V, Vercellino V. [Verrucous carcinoma of the oral cavity. Personal experience with combined chemo-surgical treatment]. Minerva Chir. 1993 Mar 15. 48(5):213-9. [Medline].

  78. Buschke A. Berliner Dermatologische Gesellschaft. Sitzung am Dienstag, den. Dezember 1931. Dermatol Zeitschr. 1932. 63:408-423.

  79. Buschke A. Condyloma acuminata. Neisser, ed. Stereoscopischer Medicinisher Atlas. Germany: Kassel; 1896.

  80. Buschke A, Lowenstein L. Uber Carcinomahnliche Condylomata Acuminata des Penis. Klin Wochenschr. 1925. 4:1726-1728.

  81. Buschkle A, Lowenstein L. Uber die Beziehungen von spitzen kondylomen zu Karzinomen des dPenis. Deutsche Med Wochenschr. 1932. 58:809-810.

  82. Jablonska S, Schwartz RA. Giant condyloma acuminatum of Buschke and Lowenstein. Demis DJ. Clinical Dermatology. 18th. Philadelphia, Pa: JB Lippincott; 1991. 1-5.

  83. Rogozinski TT, Schwartz RA, Towpik E. Verrucous carcinoma in Unna-Thost hyperkeratosis of the palms and soles. J Am Acad Dermatol. 1994 Dec. 31(6):1061-2. [Medline].

  84. Schwartz RA. Buschke-Loewenstein tumor: verrucous carcinoma of the penis. J Am Acad Dermatol. 1990 Oct. 23(4 Pt 1):723-7. [Medline].

  85. Schwartz RA. Verrucous carcinoma of the skin. Demis DJ, ed. Clinical Dermatology. 18th ed. Philadelphia, Pa: JB Lippincott; 1991. 1-8.

  86. Schwartz RA. Keratoacanthoma. J Am Acad Dermatol. 1994 Jan. 30(1):1-19; quiz 20-2. [Medline].

  87. Schwartz RA, Bagley MP, Janniger CK, Lambert WC. Verrucous carcinoma of a leg amputation stump. Dermatologica. 1991. 182(3):193-5. [Medline].

  88. Schwartz RA, Burgess GH. Verrucous carcinoma of the foot. J Surg Oncol. 1980. 14(4):333-9. [Medline].

  89. Schwartz RA, Hill WE, Hansen RC, Fleishman JS. Verrucous malignant melanoma. J Dermatol Surg Oncol. 1980 Sep. 6(9):719-24. [Medline].

  90. Schwartz RA, Nychay SG, Lyons M, Sciales CW, Lambert WC. Buschke-Löwenstein tumor: verrucous carcinoma of the anogenitalia. Cutis. 1991 Apr. 47(4):263-6. [Medline].

  91. Trimble JW, Schwartz RA. Mohs micrographic surgery. Schwartz RA, ed. Skin Cancer Recognition and Management. New York, NY: Springer-Verlag; 1988. 339-45.

  92. Wick MR, Manivel C, Millns JL. Histopathologic considerations in the management of skin cancer. Schwartz RA, ed. Skin Cancer: Recognition and Management. New York, NY: Springer-Verlag; 1988. 246-75.

 
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