Verrucous carcinoma (VC) is one of those conditions that can easily be misunderstood, even by those familiar with more common types of cancer. As a rare and unusual form of squamous cell carcinoma, its slow growth, distinct appearance, and relatively low metastatic potential can lead to confusion about its nature, seriousness, and treatment. Unfortunately, many misconceptions about this type of cancer persist, sometimes causing delays in diagnosis and proper care. Below, we'll tackle some of the most prevalent myths and misconceptions surrounding verrucous carcinoma.
At first glance, this misconception seems understandable. After all, the term "verrucous" literally refers to a wart-like appearance. However, verrucous carcinoma is not a benign wart. It is a form of cancer, meaning it involves the uncontrolled growth of abnormal cells that can invade nearby tissues.
The confusion likely stems from the appearance of the cancer. Verrucous carcinoma often forms thick, bumpy lesions that resemble warts or calluses, particularly in its early stages. However, unlike common viral warts caused by the human papillomavirus (HPV), verrucous carcinoma is a malignant tumor that requires medical intervention. While HPV may play a role in the development of some types of VC, the two conditions are fundamentally different in terms of their risk and impact.
This is one of the most damaging misconceptions about verrucous carcinoma. Many people mistakenly believe that because VC rarely spreads (metastasizes) to distant organs, it isn't a "real" cancer or it doesn't need aggressive treatment. This couldn't be further from the truth.
While it's true that verrucous carcinoma has a much lower metastatic potential compared to other forms of squamous cell carcinoma, it can still be a locally aggressive cancer. VC tends to grow slowly but invades surrounding tissues, causing significant damage if left untreated. For example, oral verrucous carcinoma can destroy gums, teeth, and underlying bone if not addressed. In genital or plantar cases, it can invade deep tissues, leading to serious complications.
The lack of metastasis doesn't make the cancer less dangerous - it simply means that its impact is more localized. Treatment is still necessary to prevent extensive tissue damage, disfigurement, and functional impairments.
Like many forms of cancer, verrucous carcinoma is often thought of as a condition that only affects older adults. While it's true that the risk of developing many cancers, including VC, increases with age, younger individuals are not immune.
Certain risk factors can increase the likelihood of developing verrucous carcinoma at a younger age. For instance, individuals who use smokeless tobacco or have long-standing infections with human papillomavirus (HPV) may develop oral or genital forms of VC earlier in life. Chronic irritation or inflammation in specific areas, such as the soles of the feet, can also lead to the development of plantar verrucous carcinoma, even in younger individuals.
It's essential to recognize that anyone with persistent lesions, especially in the mouth, genital region, or feet, should seek medical evaluation regardless of their age. Early detection is key to effective treatment.
Because verrucous carcinoma grows so slowly, some people believe it's a condition that can be safely monitored without intervention. This is a dangerous misconception. Although VC doesn't usually spread to distant parts of the body, it can cause serious damage to the area where it develops.
For example, oral verrucous carcinoma can invade deep into the tissues of the mouth, affecting not only the gums and teeth but also the jawbone. Similarly, plantar VC can penetrate through layers of skin and into deeper structures, making it difficult to treat later on. The longer the tumor is left untreated, the more extensive the surgical intervention may need to be, sometimes requiring more tissue to be removed and leading to functional deficits.
While VC may not have the urgency associated with rapidly spreading cancers like melanoma, it should not be left untreated. Early treatment can significantly reduce the risk of serious complications and the need for extensive surgery.
Human papillomavirus (HPV) infection is known to play a role in the development of some types of verrucous carcinoma, particularly those affecting the genital and anal regions. However, it's a misconception to assume that all cases of VC are caused by HPV.
In fact, while genital VC (such as Buschke-Löwenstein tumor) is often linked to HPV types 6 and 11, other forms of VC may develop due to entirely different factors. Oral verrucous carcinoma, for example, is frequently associated with the use of smokeless tobacco rather than HPV infection. Meanwhile, plantar VC is usually linked to chronic irritation or trauma to the soles of the feet, not to viral infection.
The role of HPV in verrucous carcinoma varies depending on the type and location of the tumor. While HPV vaccination may help reduce the risk of certain forms of VC, other preventive measures, such as avoiding tobacco products and protecting the skin from chronic injury, are also important.
Surgical excision is indeed the most common and effective treatment for verrucous carcinoma. However, it's not the only option available, especially in cases where surgery may not be feasible or desired by the patient. Radiation therapy, though used cautiously in VC cases, can sometimes be an option for patients who cannot undergo surgery or for tumors that recur after initial treatment.
It's also important to note that surgery for VC often involves removing a margin of healthy tissue around the tumor to ensure that all cancerous cells are eliminated. For some patients, this can lead to concerns about cosmetic outcomes or functional impairments, particularly when VC affects sensitive areas like the mouth or genitals. Reconstructive surgery or other restorative procedures may be necessary to restore function and appearance after tumor removal.
In addition to surgical and radiation options, certain topical treatments may be considered in very early or superficial cases, although these are generally less effective for verrucous carcinoma due to its invasive nature. The treatment approach will depend on the size, location, and stage of the tumor, as well as the patient's overall health and preferences.
While verrucous carcinoma has a relatively high rate of recurrence compared to some other cancers, it's a misconception to assume that it always comes back after treatment. Recurrence rates can vary depending on the location of the tumor, the type of treatment used, and how thoroughly the cancerous cells were removed during the initial intervention.
For instance, Mohs micrographic surgery, which involves removing the tumor layer by layer and examining each layer under a microscope to ensure clear margins, has a lower recurrence rate than traditional excision methods. However, some forms of VC, particularly those in difficult-to-treat areas like the oral cavity or genital region, may have a higher likelihood of recurrence.
The risk of recurrence also depends on the patient's ability to manage any underlying risk factors. For example, patients with oral VC who continue using smokeless tobacco may be at higher risk for the cancer returning. Similarly, those with HPV-associated VC may need ongoing monitoring to ensure that new lesions don't develop.
Verrucous carcinoma is actually a group of cancers that share similar characteristics but can differ significantly depending on their location and cause. As mentioned earlier, there are different types of VC, including oral, genital, and plantar forms. Each type may behave somewhat differently, and the treatment approach may vary based on the tumor's location and specific risk factors.
For example, oral verrucous carcinoma tends to be more invasive and difficult to treat than plantar VC, which may be more localized and easier to remove surgically. Genital VC may be more likely to recur due to its association with HPV, while oral VC may respond well to treatment if detected early and tobacco use is discontinued.
Recognizing these distinctions is important for both patients and healthcare providers when determining the best course of treatment and follow-up care.
While it's true that verrucous carcinoma most commonly affects certain areas, such as the mouth, genitals, and feet, it can develop in other regions as well. VC can occur anywhere that squamous cells are present, including the larynx, esophagus, and even the nasal cavity in rare cases.
It's important to be aware that verrucous carcinoma can develop in any mucous membrane or skin surface that is subject to chronic irritation, infection, or other risk factors. Therefore, anyone with persistent lesions, particularly in areas where VC is known to occur, should seek medical evaluation.
Finally, one of the biggest misconceptions about verrucous carcinoma is that it's easy to diagnose early due to its slow growth. In reality, VC is often misdiagnosed or mistaken for a benign condition like a wart, callus, or non-cancerous growth. Its well-differentiated appearance in biopsy samples can make it difficult to distinguish from non-cancerous lesions, especially in the early stages.
This difficulty in early diagnosis is one reason why verrucous carcinoma may go untreated for long periods, allowing it to invade deeper tissues. A thorough evaluation by a specialist who is familiar with VC is often necessary to ensure an accurate diagnosis.