Verrucous Carcinoma of the Lower Lip: A Rare Case Mimicking Benign Lesion

Background: Verrucous carcinoma (VC) is a rare, well-differentiated subtype of squamous cell carcinoma characterized by slow growth and local invasiveness. Although it can arise in various anatomical regions, involvement of the lip is uncommon. Because VC may clinically resemble benign verrucous lesions such as squamous cell papilloma, accurate diagnosis is often delayed. This case report aims to illustrate the diagnostic pitfalls encountered when lower-lip VC is managed as a benign verrucous lesion and to emphasize the need for adequately deep or excisional biopsy in persistent lesions that fail to respond to conservative treatment. Methods: We report the case of a 75-year-old man who presented with a persistent, cauliflower-like lesion on the lower lip initially diagnosed as verruca. Despite repeated cryotherapy, the lesion enlarged. Wide local excision was performed under general anesthesia, and frozen biopsy suggested malignancy. The resultant defect was reconstructed using a step-ladder advancement flap designed to preserve lip symmetry and function. Results: Histopathologic examination revealed a well-differentiated squamous epithelium with parakeratinized invaginations extending into the stroma, confirming VC. The postoperative course was uneventful, with preserved oral competence and no evidence of recurrence during follow-up. Conclusions: Verrucous carcinoma of the lip can be misdiagnosed as a benign papillomatous or verrucous lesion, particularly when only a superficial biopsy is obtained and management relies on prolonged conservative therapy such as repeated cryotherapy. Persistent verrucous lesions of the lip that do not respond to an apparently adequate course of treatment should prompt reconsideration of the diagnosis and performance of an adequately deep or excisional biopsy. Complete excision with negative margins remains the treatment of choice, and increased clinical awareness, together with careful histopathologic evaluation, are essential for early detection and appropriate management, ultimately improving patient outcomes and minimizing morbidity.