eMedicine Specialties > Dermatology > Malignant Neoplasms

Verrucous Carcinoma: Differential Diagnoses & Workup

Author: Bassam Zeina, MD, PhD, Consulting Staff, Department of Dermatology, Milton Keynes Hospital, UK
Coauthor(s): Nicole Sakka, MBBS, Senior House Officer, Department of Dermatology, Milton Keynes Hospital, NHS Foundation Trust, UK; Sohail Mansoor, MBBS, MSc, Dermatologist and Lead Physician in Dermatologic Surgery, Department of Dermatology, Barnet Hospital, UK
Contributor Information and Disclosures

Updated: Jul 9, 2009

Differential Diagnoses

Keratoacanthoma
Warts, Genital
Warts, Nongenital

Other Problems to Be Considered

Vegetating pyoderma
Pseudoepitheliomatous hyperplasia
Giant condyloma acuminatum
Lesions that appear inflammatory rather than neoplastic

Workup

Imaging Studies

Computed tomography or magnetic resonance imaging may be used to demonstrate the exact location and extent of the verrucous carcinoma (VC) tumor for preoperative staging and surgical planning.

Procedures

  • A skin biopsy always is required for definitive diagnosis of verrucous carcinoma, despite the fact that the diagnosis is suspected strongly on clinical grounds.
  • Biopsy is performed routinely in the physician's office using a local anesthetic.
  • All skin biopsy specimens obtained to diagnose verrucous carcinoma must reach at least the depth of the mid dermis to allow for determination of the presence or absence of invasive disease.
  • A deep (scoop) shave biopsy, a punch biopsy, an incisional biopsy, or an excisional biopsy may be performed.
  • Pathology readings preferably are made by a dermatopathologist who has extensive experience with verrucous carcinoma.

Histologic Findings

Verrucous carcinoma of all types may resemble a verruca superficially, with hyperkeratosis, parakeratosis, acanthosis, papillomatosis, and granular cell layer vacuolization. Blunt projections of well-differentiated epithelium surrounded by edematous stroma and chronic inflammatory cells extend into the dermis, sometimes forming sinuses filled with keratin.

Staging

Most verrucous carcinomas are nonmetastatic and are staged based on size, as follows:

  • T0 lesions - In situ
  • T1 lesions - Less than 2 cm in diameter
  • T2 lesions - Between 2 and 4 cm in diameter
  • T3 lesions - Greater than 4 cm in diameter
  • T4 lesions - Invasive of muscle or bone

More on Verrucous Carcinoma

Overview: Verrucous Carcinoma
Differential Diagnoses & Workup: Verrucous Carcinoma
Treatment & Medication: Verrucous Carcinoma
Follow-up: Verrucous Carcinoma
References
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Further Reading

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Keywords

verrucous carcinoma, verrucous cell carcinoma, Ackerman tumor, Ackerman's tumor, Buschke-Loewenstein tumor, florid oral papillomatosis, carcinoma cuniculatum, warty cancer, epithelioma cuniculatum, squamous cell carcinoma de novo, VC

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Contributor Information and Disclosures

Author

Bassam Zeina, MD, PhD, Consulting Staff, Department of Dermatology, Milton Keynes Hospital, UK
Bassam Zeina, MD, PhD is a member of the following medical societies: British Association of Dermatologists, British Medical Association, and Royal Society of Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Nicole Sakka, MBBS, Senior House Officer, Department of Dermatology, Milton Keynes Hospital, NHS Foundation Trust, UK
Disclosure: Nothing to disclose.

Sohail Mansoor, MBBS, MSc, Dermatologist and Lead Physician in Dermatologic Surgery, Department of Dermatology, Barnet Hospital, UK
Sohail Mansoor, MBBS, MSc is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Dermatology, American Society for Dermatologic Surgery, Royal College of Physicians and Surgeons of Glasgow, and Royal College of Physicians of the United Kingdom
Disclosure: Nothing to disclose.

Medical Editor

Kelly M Cordoro, MD, Fellow and Clinical Instructor, Department of Pediatric Dermatology, University of California at San Francisco; Assistant Professor (On Educational Leave), Assistant Program Director for Resident Medical Education, Department of Dermatology, University of Virginia School of Medicine
Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Association of Professors of Dermatology, Dermatology Foundation, Medical Society of Virginia, National Psoriasis Foundation, Society for Pediatric Dermatology, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

John G Albertini, MD, Consulting Staff, Dermatologic Surgery, The Skin Surgery Center; Program Director, ACGME accredited Fellowship in Procedural Dermatology
John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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