Oral verrucous lesions need special diagnostic attention

By Sarah Guy, medwireNews Reporter

Care should be taken to diagnose oral verrucous lesions accurately according to their nature, behavior, and malignant potential, and should be differentiated from grade I squamous cell carcinoma (SCC), suggest Indian researchers.

Their study findings show that among patients presenting with such lesions, none proved to be SCC on biopsy, rather, the majority were diagnosed as verrucous carcinoma (VC) or verrucous hyperplasia (VH) - an early form of VC.

"VC of the oral cavity is a different clinicopathologic tumour distinguished from the usual squamous cell carcinoma because of its local invasiveness, non-metastasizing behaviour, and special clinical appearance," explain Divya Mehrotra and colleagues from King George's Medical University in Lucknow.

While VC is a rare, slow-growing tumor with an excellent clinical prognosis, it enlarges with direct extension rather than frank invasion and can destroy deeper tissues, they add, in the Journal of Oral Biology and Craniofacial Research.

Fifteen individuals aged a median of 45 years at diagnosis presented at the team's institution between 2007 and 2009 with verrucous lesions of the oral cavity, most frequently in the buccal mucosa (46.7%). The majority of the cohort was male (80%).

Biopsy findings revealed that five patients had VC, seven had VH, and three had proliferative verrucous leukoplakia (PVL). The latter two groups were managed by surgical excision while VC patients were managed with excision and superficial ostectomy, plus chemotherapy if micro-invasion was observed on histopathologic examination.

PVL is an aggressive type of oral leukoplakia and its rate of malignant transformation is extremely high, note Mehrotra and co-investigators.

The researchers report a 2-year overall survival and tumor control rate of 93.4% with no instances of disease recurrence after treatment in the 3-5 years of follow up available for each participant.

Oral verrucous lesions typically present as slowly enlarging gray or white, warty, exophytic overgrowths on the buccal mucosa or gingiva and cause differentiation problems for clinicians because they mimic invasive cancer, say Mehrotra et al.

However, "VC shows the characteristic cell kinetics of normal epithelium and not of conventional squamous carcinoma," they add.

To rule out the latter condition, "deeply infiltrating portions of the lesion should be excised during biopsy," concludes the research team.

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