Oral florid papillomatosis (verrucous carcinoma)

1. Florid Papillomatosis (FP) seems to be another form of verrucous carcinoma. 2. Besides the mouth, FP can be found in the larynx, nose, genitalia, skin, etc. 3. FP would appear to be a carcinoma with a low degree of malignancy, and is locally aggressive. They do not cause generalized metastases and rarely metastasize locally. 4. In the mouth, the lesions, either single or multiple, usually occur in adult men. The most frequent sites are the buccal mucosa and the alveolar-gingival area. They develop on a healthy mucosa, or on preexisting lesions, namely, leukoplakia, atypical lichen, abrasive cheilitis and traumatic ulcers. FP may cause fistulas and jaw destruction. 5. Histologically, three stages can be recognized: type I, with acanthosis and papillomatosis, etc., type II, with the aspect of an in situ carcinoma, and type III, carcinoma-like in aspect but with some characteristics of FP. 6. Ten percent of the cases may develop an anaplastic carcinoma or may become associated with other types of carcinomas in other organs and near the area where the FP appeared. 7. Predisposing factors are the same as those for classical carcinomas (especially smoking and chewing tobacco or betel). FP may develop on preexisting lesions similar to those described for regular carcinomas. No virus has been isolated. Some authors believe FP is a precancerous condition; we think it is a cancer with a low degree of malignancy. 8. Treatment should be initiated with cytostatic drugs, especially methotrexate, followed by electrocoagulation, radium implantation and surgery. If the lesions are small in size, methotrexate is not required. If the lesions are large or there is bone destruction, surgery is the treatment of choice after methotrexate and sometimes high-voltage therapy with 60Co. 9. A cure rate of 75% can be obtained in properly treated cases.