[Verrucous carcinoma. Nosologic aspects, apropos of 4 cases]

The nosology of verrucous carcinomas is a complicated problem. The name given to each manifestation may vary with localization. We report our findings in four cases with this skin disease.

Four patients, 76, 52, 76 and 55 years of age, presented with verrucous carcinoma. In the first case, the disease began with a chronic varicose ulceration localized on the anterolateral aspect of the right leg. In the second, the lesion was localized on the lateral aspect of the right leg facing a zone showing signs of repeated microtraumatisms. HPV-18 was isolated in this patient. The third case had a vegetating lesion on the dorsal aspect of the right hand, simulating a wart. The fourth case is a historic case in which a voluminous tumour developed over several years on an ulceration of the medial aspect of the left malleole, associated with trauma and venous insufficiency.

The three recent cases did not raise any particular problem with diagnosis. The diagnosis in the historical case, published in 1969 as a vegetating pyoderma, was corrected later. This illustrates the nosology problems raised in this particular form of epidermoid carcinoma which often has an impressive clinical presentation and a reassuring histology. The group of verrucous carcinomas include different skin or mucosal lesions formerly designated as oral florid papillomatosis, Buschke-Löwenstein acuminate condyloma or pseudo-epitheliomatous vegetating pyoderma. Cuniculatum epithelioma was added to this group for simplification although this rarely observed lesion is a separate entity.

The pathology diagnosis of verrucous carcinoma requires large and deep biopsy. Treatment is surgical and regular follow-up is needed as for all malignant tumours.