eMedicine Specialties > Dermatology > Malignant Neoplasms

Verrucous Carcinoma: Follow-up

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

Follow-up

Further Outpatient Care

Verrucous carcinoma (VC) usually is cured with appropriate therapy; however, patients at risk for additional verrucous carcinoma and squamous cell carcinoma should be evaluated with a skin examination at 3- to 12-month intervals.

Prognosis

Most patients with verrucous carcinoma have a good prognosis. Local verrucous carcinoma recurrence following definitive treatment is not uncommon. Regarding oral verrucous carcinoma, the reported recurrence rate ranges from 6-40%. Distant metastasis is considered rare. If metastasis does occur, it is mainly at the regional lymph nodes.7 Patients with oral verrucous carcinoma may be at an increased risk of a second primary oral squamous cell carcinoma, which carries a poor prognosis.

Patient Education

Advise patients about the importance of receiving effective treatment for areas of chronic skin inflammation or trauma (eg, leg or decubitus ulcers) to prevent these problems from developing malignancies within them. Improved oral, genital, and perianal hygiene may help to prevent inflammatory conditions that predispose patients to verrucous carcinoma. Cessation of chewing tobacco use may help to prevent oral verrucous carcinoma.

For excellent patient education resources, visit eMedicine's Cancer and Tumors Center and Warts Center. Also, see eMedicine's patient education articles Skin Cancer, Warts, and Skin Biopsy.

Miscellaneous

Medicolegal Pitfalls

The main pitfall in the diagnostic evaluation is taking an inadequate biopsy specimen. Additionally, in some cases, the carcinoma is so well differentiated that the pathologist may read the tissue as pseudoepitheliomatous hyperplasia. Verrucous carcinoma has the potential to cause substantial morbidity and even mortality, and physicians who diagnose and treat verrucous carcinoma are held legally accountable for their actions.

Failure to ensure adequate patient follow-up care is a pitfall because primary treatment of verrucous carcinoma is not a guarantee of cure. Not informing patients of the potential morbidity associated with verrucous carcinoma may lead to the lesion being regarded as trivial and not requiring follow-up care. The courts hold the physician, not the patient, responsible for appropriate follow-up care. Missed appointments for patients with verrucous carcinoma before or following surgery may indicate a worried or angry patient and should be followed up with a phone call to reschedule and, if necessary, with a certified letter.

Failure to outline all possible risks prior to verrucous carcinoma surgery is another pitfall. Surgery for patients with verrucous carcinoma may cause bleeding, infection, scar formation, deformity, and nerve damage. Removal of deeply invasive lesions may lead to substantial morbidity, including pain syndromes and paralysis. If a surgical complication develops, the physician who performed the primary procedure is held legally responsible, regardless of who handles the complication. Any patient with lesions that are outside the realm of comfort of an individual physician should be referred to another physician.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, Willam D. James, MD, and previous author, Mohsin Ali, MBBS, FRCP, MRCP, to the development and writing of this article.



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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