The Fate of Oral Cavity Verrucous Hyperplasia in a Diagnostic Biopsy: A Conundrum for Subsequent Management

Oral cavity verrucous growth can be benign, malignant, or have the potential for malignant transformation. The present study aims to explore the hypothesis that all preoperatively diagnosed oral cavity verrucous hyperplasia (OCVH) carry a risk of malignancy in subsequent resection specimens and to re-analyse the risk factors that would indicate malignancy in these patients. This is a retrospective analysis of consecutively diagnosed 30 patients with OCVH on diagnostic biopsy who presented at our institute between February 2018 and January 2021. Among these, patients with malignancy in their final histopathological examination (HPE) were re-analysed for potential clinicopathological risk factors that could anticipate malignancy preoperatively. On subsequent resection, 53.4% (16) of patients had invasive malignancy, 10% (3) of patients had high-grade dysplasia, and 3.3% (1) of patients had mild dysplasia on the final HPE. Thus, only 30% (9) of patients had retained the pre-operative diagnosis of verrucous hyperplasia without dysplasia (3.3% (1) patient was given radical radiotherapy and was excluded from analysis). In addition, age ≥ 50 years (p value = 0.006), repeat biopsies (p value = 0.009), and bone erosion on imaging (p value < 0.001) were clinical-radiological risk factors significantly associated with the risk of malignancy at diagnosis in linear regression analysis. The risk of malignancy can be stratified with proper patient evaluation after a thorough history and clinical-radiological assessment in patients with OCVH on diagnostic biopsy. Thus, these lesions should undergo formal oncologic resection if clinical-radiological suspicion is high, even if preoperative biopsy is negative.