Nascent verrucous hyperplasia - A transition to cutaneous squamous cell carcinoma

Cutaneous squamous cell carcinoma is a common global cancer with Ultraviolet light recognized as the most significant risk factor. The other definite or plausible risk factors include immunosuppression, infection with oncogenic viruses, exposure to toxins, chemicals, chronic inflammatory skin disease and a high body mass index. This case highlights the rarity of the pathology in terms of size, the subtle transition of verrucous hyperplasia to cutaneous squamous cell carcinoma over a period of time and the fallibility of the frozen section report in deciding the optimum resection margins. The initial innocuous presentation represented a diagnostic challenge as it can be mistaken for other benign entities. A correlation between the history, clinical presentation, tumor biology and the histopathological characteristics helped us to unlock the jigsaw puzzle of approaching a rare condition with a modification in the surgical approach.