If a wart is extremely large and resistant to conventional therapies, consider a diagnosis of verrucous carcinoma. This is a rare, low-grade, well-differentiated carcinoma that usually occurs on the plantar surface. It is slow growing and can become deeply invasive. Reports of metastases exist, although they are rare. A verrucous carcinoma can be misdiagnosed easily as a common wart, since they two share similar clinical and histologic characteristics. Be aware of this entity, and consider a deep incisional biopsy of any lesion that is extensive and not responsive to treatment.
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