Acral Verrucous Carcinoma

The verrucous carcinoma is a type of squamous carcinoma that is highly differentiated, relatively uncommon, locally aggressive, with slow growth and minimal metastatic potential.

A 48-year old man was admitted to the Dermatology department of the Craiova Hospital for a round-oval tumoral mass that was hyperkeratotic, with central ulceration, covered by a hematic crust, approximately 1.5cm in size, localized at the distal phalanx of the third finger left hand, with perilesional edema and erythema. The wart-like lesion appeared 8 months beforehand, which the patient has traumatized repeatedly in the last 2 months. The histopathological examination confirmed the diagnosis of verrucous carcinoma. The X-ray examination revealed external margin osteolysis of the distal epiphysis in the third finger, left hand. The patient was transfered to the Plastic surgery department where the distal phalanx of the third finger, left hand was amputated.

Risk factors for the development of verrucous carcinoma are HPV infection, carcinogenic chemicals, smoking, chronic inflammation, repeated trauma, etc. Diagnosis is suspected by clinical appearance and confirmed histopathologically. The treatment of choice is surgical excision due to the high risk of recurrence and local invasiveness, and in the case of an advanced tumor with acral localization, amputation is preferred, as is our case.

Verrucous carcinoma is a type of squamous carcinoma that is highly differentiated, with slow and continuous invasion of the underlying tissues. In order to establish the diagnosis of verrucous carcinoma, it is necessary to corroborate the clinical examination with histopathological and evolutionary examinations. The treatment of choice is surgical excision, but given the increased risk of recurrence, the patient should be evaluated periodically until complete healing. Our case is interesting by localization and rapid evolution with the invasion of the underlying tissues.