Oral verrucous lesions: Controversies in diagnosis and management

Oral verrucous lesions, typically presenting as slowly enlarging, grey or white, warty, exophytic overgrowths on the buccal mucosa or gingiva may be verrucous carcinoma (VC), verrucous hyperplasia (VH), proliferative verrucous leukoplakia (PVL), or may show the conventional invasive pattern of squamous cell carcinoma (SCC). This study was undertaken with the aim to report the demography of different types of oral verrucous lesions and evaluate their long-term outcome.

This clinical study comprised 15 patients with verrucous lesions of the oral cavity who underwent biopsy for confirmation of diagnosis.

Among these, 12 (80%) were male and only three (20%) were female. The age distribution ranged from 32 to 74 years with a median age of 45 years at the time of diagnosis. The most common site of VC within the oral cavity was the buccal mucosa (46.7%). 5 were proven cases of VC, 3 PVL and 7 VH. All cases of VH, PVL were managed by surgical excision, while VC was managed by surgical excision with superficial ostectomy followed by two cycles of chemotherapy additionally, if micro-invasion was observed on histopathological examination. The 2-year overall survival and tumour control rate was 93.4%. Recurrence was not seen in any patient till the time of analysis at a follow up of 3-5 years.

Accurate diagnosis of the verrucous lesions is important and should be differentiated from grade I squamous cell carcinoma. Management should be based upon the nature, behaviour and malignant potential of the lesion.