Verrucous squamous cell carcinoma of the oral cavity

Verrucous-type oral tumors have been reviewed. This variety of epidermoid carcinoma of the oral cavity presents as a warty growth in patients who have a history of chewing tobacco and poor oral hygiene. They are slow-growing, locally invasive, and do not metastasize to lymph nodes in our experience. In five of these patients, the microscopic pattern was that of a well-differentiated squamous cell carcinoma. The others presented the classical histologic pattern of verrucous carcinoma. No difference was found in the behavior of these two groups. Three cases developed anaplastic transformation after irradiation and surgery. A change in the clinical behavior of the tumor was observed in these patients and all three died. There is some possibility that ionizing radiations could be the trigger mechanism in this transformation. The authors feel that surgery is the treatment of choice in early or easily resectable lesions. It would appear unnecessary to perform neck dissection in these patients. Radiation therapy should be used in advanced verrucal-type lesions in which surgical resection is difficult or not feasible. These patients require frequent and careful observation. The authors believe that this entity deserves further investigation.