Verrucous carcinoma of the temporal bone: a wolf clothed in wool

Verrucous carcinomas are rare tumors that predominantly affect the head and neck region. A paradox of slow, aggressive invasion, apparent lymphadenopathy, yet seemingly bland histopathology, they can beguile unwary clinicians into multiple diagnostic biopsies and regional lymphadenectomy. We report a rare verrucous carcinoma of the temporal bone associated with extensive destruction around the skull base. Placed in the context of the few reports involving this site, extratemporal spread may be associated with a uniformly poor prognosis regardless of the treatment modality. Given new insights into the pathophysiology of this tumor, palliative radiotherapy may be a more appropriate primary treatment compared with the significant local morbidity associated with surgery.