Histologic Variants of Squamous Cell Carcinoma of the Skin

Margaret H. Rinker, MD; Neil A. Fenske, MD; Leigh Ann Scalf, MD, and L. Frank Glass, MD, Division of Dermatology and Cutaneous Surgery, Department of Internal Medicine at the University of South Florida, Tampa, Fla.

Cancer Control. 2001;8(4) 

In This Article

Verrucous Carcinoma of the Oral Cavity

Verrucous carcinoma of the oral cavity was first reported by Ackerman[20] in 1948. In 1960, Rockand Fisher[23] described a similar lesion, which they named oral florid papillomatosis. It is now agreed that oral florid papillomatosis merely represents a verrucous carcinoma of the oral cavity. It has also been referred to as Ackerman tumor or verrucous carcinoma of Ackerman.

Clinically, oral florid papillomatosisis most commonly seen in elderly white men. In its early stages, it appears as a white keratotic patch. Later, it appears as a soft,rubbery, papillary growth that may have ulceration. It occurs most commonly on the buccal mucosa and the gingiva.[30] Patients may have lymph adenopathy due to secondary infection. There is a definite association with tobacco use,including smoking, snuff dipping,and betel chewing,all of which may cause leukoplakia. The tumor is most frequently preceded by leukoplakia,which was noted in up to 57% of patients in one series. It may also be preceded by oral lichen planus, chronic candidiasis, and chronic lupus erythematosus.[30]

Histology reveals a sharply circumscribed tumor, with marked papillomatosis and overlying hyperkeratosis.Broad bulbous acanthotic projections of epidermis may extend deep into the stroma.An associated dense inflammatory cell infiltrate is often present. As with other forms of verrucous carcinoma,little atypia is present inmost cases.

Although distant metastases are rare, local destruction may occur, with invasion into bone. The treatment of choice is surgical excision.Radiation therapy should be avoided due to the risk of anaplastic transformation to a more aggressive form of SCC.[31]


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