Intranasal verrucous carcinoma with autoinoculation from benign warts in the context of locus minoris resistentiae

Verrucous carcinoma is a rare, highly differentiated subtype of squamous cell carcinoma, more closely resembling a reactive process than conventional invasive squamous cell carcinoma. It is characterized by local invasion of adjacent normal tissue and low metastatic potential. Verrucous carcinoma may occasionally involve the nasal mucosa, with initial symptoms including regional discomfort, nasal obstruction, or the presence of a visible intranasal lesion that drives the patient to the initial consultation. The pathogenesis of verrucous carcinoma is not yet fully understood, and the role of infectious factors, such as human papillomavirus (HPV), remain a subject of debate. We present a 50-year-old male with verrucous carcinoma arising in the left nasal vestibule, developing following possible autoinoculation (based on anamnestic data) at the site of prior nasal trauma from a smaller, common facial wart. The patient had previously undergone partial resection of the septal cartilage, and cicatricial tissue was present in the same area as a result of earlier surgical intervention. The exophytic lesion was surgically excised and subsequently electrocauterized. No residual macroscopic tumor was observed. Koilocytosis was identified on histopathological examination. Immunohistochemical analysis demonstrated p16 overexpression. Previously histologically confirmed facial HPV-related warts support the possible HPV involvement in the pathogenesis of verrucous carcinoma and establish its role as not so controversial.