Verrucous carcinoma of the mouth

This paper describes a survey of 198 cases of oral verrucous carcinoma reported in the literature and a study of a further 15 personally‐observed cases. Elderly Caucasoid males are most frequently affected, although in the South African group there were 10 females and 5 males. The lesion, which classically has a verrucous surface, may be small or more extensive. The cheek mucosa and the alveolar mucosa/gingiva are the sites most commonly involved. Sometimes more than one area is affected in the same patient and the tumor may be associated with other lesions such as leukoplakia, pseudo‐epitheliomatous hyperplasia and frank carcinoma. The etiology is uncertain but tobacco usage in any form appears to be implicated. The tumor is locally invasive and 6 of our series of 15 recurred after surgical removal. It does not metastasize unless it undergoes anaplastic transformation, which it frequently does if treated with radiotherapy. The correct treatment is therefore wide surgical excision. Histologically, there is a typical abrupt margin. The tumor has surface papillary projections and infiltrating broad, blunt rete pegs which form a “pushing margin”. The epithelium is generally well‐differentiated but there may be a high mitotic index and there may be an appearance of epithelial atypia if the epithelium is inflamed. Keratin is usually present on the surface and in the crevices of the deep invaginations but may be absent from tumors involving non‐kcratinizing surfaces.