What Is Verrucous Carcinoma?

Verrucous carcinoma is a subtype of skin cancer called squamous cell carcinoma, but it is slower growing and is linked to better patient outcomes.¹ It can occur in the skin or on mucous membranes, especially in the mouth. Chronic irritation from things like alcohol and smoking is reported to cause this condition. This condition occurs mostly in older people.²

Overview

Verrucous carcinoma is a subtype of squamous cell carcinoma(SCC). Even under the microscope, this cancer appears bland, unlike most cancers, which show more aggressive features in the cells. Hence, this diagnosis can be easily mistaken for something non-cancerous. Verrucous carcinoma is a cancer of older people, and the outcome is generally better than other forms of skin cancer.

What are the symptoms and signs of verrucous carcinoma?

Verrucous carcinoma commonly appears as a wart on the skin.¹ The warts appear to grow and worsen with time. Sometimes, these warts can have ulceration, itching, and irritation on their surface. 

What are the particular areas of the body that are commonly affected by verrucous carcinoma?

The occurrence of the wart is reported to be more common in certain parts of the body compared to others. These areas include the following: 

• Toes, hands, foot, and nail bed
• Eyelids
• Scalp
• Buttocks/ anorectal region
• Vulva³
• Shoulder 
• Axilla
• Abdominal wall
• Mouth and lips

How is it different from other skin cancers?

Verrucous carcinoma grows much more slowly and is less likely to spread to lymphatics, blood vessels and other organs.³ This makes it very different from other skin cancers like melanoma.

Who is at risk of getting verrucous carcinoma?

This is a condition that occurs mostly in the elderly. The mean age range is around 50 years to 70 years. It is said to occur more in those who are assigned male at birth(AMAB) compared to those who are assigned female at birth(AFAB).¹

What causes verrucous carcinoma?

Multiple factors are involved in causing verrucous carcinoma, and they are all linked to chronic irritation. These include

• Chronic irritation  from alcohol consumption, smoking and eating areca nut
• Chronic inflammation from  ulcers and burns 
• Chronic inflammation from Lichen sclerosus

Can verrucous carcinoma be passed down to family members?

This is not a genetically acquired condition and does not pass down to family members.

How is verrucous carcinoma diagnosed?

The definitive diagnosis is through collecting a skin sample from a  skin biopsy. This involves removing a tiny piece of skin from the body whilst the patient is put under local anaesthesia. This sample is then processed and viewed in the lab. This will show the characteristic pattern of the tumour cells and determine if there is any invasion into deeper tissues like the underlying bone.¹ In some instances, imaging, like CT scans, is used to see how far the cancer has invaded the body, staging the cancer and helping in determining surgical plans.²

What are the treatment options for verrucous carcinoma?

Complete removal by surgery is the first-line option of treatment. It is important to remove this cancer completely, preventing it from reoccurring again in the body. Other options include radiotherapy, laser treatment and cryotherapy.

What is the outcome of verrucous carcinoma?

The patient outcome for verrucous carcinoma is generally positive if the tumour is completely removed by surgery. 

Despite this, if it is incompletely removed by surgery, verrucous carcinoma tends to recur.

When it recurs, it can be more aggressive, with a worse patient outcome than the first time.²

Rarely it can recur as a squamous cell carcinoma, too.¹

Spreading to other organs is somewhat rare; however, when it does spread, it commonly spreads from lesions in the mouth. The lymph nodes in the area where the verrucous carcinoma has occurred tend to become enlarged.²

What is the follow-up plan after verrucous carcinoma has been removed surgically?

It is recommended that after treatment of verrucous carcinoma, patients should be followed up at 3-12 monthly intervals to check for recurrences.² This includes:

• Regular checkups such as physical examinations, imaging tests and potentially more biopsies.
• Periodic imaging such as CT scans, MRIs and PET scans
• Dental examinations to check for recurrence of cancer, specifically in the mouth 
• Guidance on improving diet and physical activity will also be provided

How can I prevent verrucous carcinoma?

The best way to prevent verrucous carcinoma is to avoid risk factors that can cause chronic inflammation of skin, such as alcohol and smoking. Noticing any skin lesions that seem to grow slowly and seeking medical advice early would be the next best thing to do for a better outcome with this disease.

Living with verrucous carcinoma

Living with verrucous carcinoma can be challenging, but it's important to know that with the right support and care, it's possible to maintain a fulfilling life. This skin cancer type often grows slowly, and treatment can be effective, which means that many individuals can continue their daily routines and activities. Regular follow-up appointments with healthcare professionals are crucial to monitor the condition and ensure any changes are promptly addressed. Emotionally, it's essential to lean on a support network of friends and family, as dealing with any form of cancer can be emotionally taxing. Staying informed about the condition and its treatment options can also empower you to make the best decisions for your health. Remember, many people live well with verrucous carcinoma, so maintaining a positive outlook and seeking support when needed can make a significant difference in your quality of life.

Summary

Verrucous carcinoma is a slow-growing skin cancer and it is a subtype of squamous cell carcinoma. It commonly arises in the skin, on hands and feet and mucous membranes like the mouth or even genitalia in older people. This cancer appears like a wart that grows slowly, and treatment is usually surgical. The outcome is generally good, and its spread to lymphatics and other organs is reported to be quite rare. Regular follow-up after surgery is needed as verrucous cancer can recur with a worse outcome.