Definition:
Verrucous Carcinoma is a diffuse papillary, non metastasizing, well differentiated malignant neoplasm of the oral epithelium.
Synonyms:
Ackerman’s tumor.
Etiology:

  • Tobacco Chewing
  • Snuff dipping habits – Moistened smokeless tobacco
Clinical Features:
Age: Above 60 yrs
Sex: Males > Females
Site/Location:


  • Most common: Gingiva, alveloar mucosa and buccal mucosa
  • Less common: Floor of the mouthVerrucous carcinoma
Differential Diagnosis:

  • Papillary hyperplasia
  • Verrucous leukoplakia
  • Squamous cell carcinoma
  • Chronic hyperplastic candidiasis
Clinical presentation:

  • Clinicalls it appears as a slow growing, exphytic, papillary growth having a white pebbly surface.
  • The surface fo the lesion is sometimes warty and it shows multiple rugae like folds with deep clefts in between.
  • Number: Can be Single or multiple
  • Leukoplakia may be seen
  • Mostly exophytic type but few lesions may be invasive type, invading into the underlying bone.
  • Lesions in the buccal mucosa are very extensive causing Pain and tenderness and dysphagia.
  • Lesions in the gingiva and alveolar mucosa become rapidly fixed to
    the periosteum and cause gradual invasion and destruction of the jaw
    bone.
  • regional lymph nodes are tender and
  • enlarged due to secondary infection.
Histopathology:

  • Hyperplastic epithelium with papillary surface covered by thick layer of para keratin.
  • Rete Ridges: Enlarged bulb like acanthotic invaginating into the
    underlying connective tissue. project into the underlying connective
    tissue at the same level called as “Pushing Margin”
    Verrucous Carcinoma histology



  • “Parakeratin plugging” is seen
  • The malignant cells are well differentiated and usually show normal level of maturation
  • Abnormal mitotic activity is found in these cells.
  • Cytologic atypia is absent
  • Epithelial Pearls and Microcysts are seen.
  • Well demarcated borders.
  • Intact basement membrane and underlying connective tissues shows intense inflamatory cell infiltrate.
Treatment:
Surgical Excision and Laser Therapy
Prognosis:

Good