Etiologymost VC appear to be related to the used of spit tobacco, either snuff or chewing tobacco.HPV found in 28% but unclear if relevant

VC most often occurs in the buccal mucosa, alveolar ridge and gingivae, tongue, floor of the mouth, and palate of elderly patient.

The average age : male over the age 55 and 71 years for women.

Early lession appear as white patches , whereas more fully developed lession display a cauliflower-like papillary apperarance that spreads over a large area of the mucosa.

exophytic, warty or plaque-like; granular, red-white, hyperkeratotic; 1-10 cm; may invade adjacent soft tissue and bone

The margin are usually well defined and characteristically show a rim of slightly elevated mucosa where the tumor has pushed under the edge of the normal tissue and has undermined it slightly.

Verrucous carcinoma most often develops at the site of placement of tobacco quid.

Verrucous carcinomas are slow-growing lesions. Although they invade adjacent structure, they do not trend to metastasize.

VC is a slow growing progressive neoplasm with a clinical phase that last several years.

Methatasis occurs rarely if ever. However, VC can transform into SCC and adopt a more aggressive behaviour.

Extremely deceptive, many cases have been diagnosed originally as a simple papilloma or benign epitelial hyperplasia, because of the orderly n harmless appearance of the specimen.

Characteristically, cleftlike spaces lined by a thick layer of parakeratin extend from the surface deeply into the lesion.

The invasive downgrowth of the epitellium, and the cronic inflammatory cell just below invading epitellium.

Verrucous carcinoma

Condyloma Acuminatum Oral Squamous Papilloma Verruca Vulgaris Leukoplakia

Surgical removal is the treatment of choice. Cryotherapy (freezing) also has a high cure rate for well-circumscribed lesions.

For large oral lession of VC may benefit from a combination of surgery and radiation therapy. Chemotherapy with bleomycin has also been used with some success to shrink the tumor before excision.

Most patients have a good prognosis, as metastasis is rare. However, if SCC is identified within the verrucous carcinoma, the prognosis becomes much less favorable