Verrucous squamous cell carcinoma is a relatively uncommon variant of squamous cell carcinoma, a type of skin cancer that originates in squamous cells. These flat, scale-like cells make up the epithelial layer of various tissues and organs.

While verrucous squamous cell carcinoma usually originates in the oral mucosa and gums, it can also develop in other mucous membrane-lined areas, such as the genital and anal regions. Typically, the tumor is slow-growing and has a warty (verrucous) surface with a distinctive, cauliflower-like appearance. If left untreated, the tumor may invade nearby tissues, but it is unlikely to metastasize to distant areas of the body.

Verrucous squamous cell carcinoma causes and risk factors

Like all cancers, verrucous squamous cell carcinoma results from accelerated cell growth triggered by cellular DNA damage. While the exact cause of the damage is unclear, experts believe it primarily develops in response to chronic inflammation or exposure to cancer-causing substances (carcinogens). Some risk factors include:

Long-term irritation or trauma to the mucous membranes in the oral cavity, which can result from rough-edged teeth or ill-fitting dentures or dental appliances
Tobacco use and excessive alcohol consumption, which can introduce carcinogens into the oral tissues
Human papillomavirus (HPV), which is a known risk factor for all types of squamous cell carcinoma
Occupational exposures to irritants and carcinogens found in certain industrial and chemical work environments
A genetic predisposition to cancer development

It is important to note that verrucous squamous cell carcinoma is most often associated with chronic exposure to risk factors over a long period, which can lead to genetic mutations in squamous cells. The cancer is most commonly seen in older adults who may have had many years of exposure to risk factors.

Verrucous squamous cell carcinoma signs and symptoms

The symptoms of verrucous squamous cell carcinoma can vary depending on the location of the tumor:

Oral Cavity

Painless oral lesions that are slow-growing, warty and white or grayish in color
Chronic sores or ulcers that do not heal
Discomfort that causes difficulty chewing and swallowing
Vocal changes

Genital Area

Wart-like lesions on the vulva (in females) and the penis (in males)
Pain and itching around the genitals
Bleeding genital ulcers

Anal Region

Wart-like growths or lumps around the anus
Pain or discomfort, especially during bowel movements
Bleeding anal lesions

It is important to note that verrucous squamous cell carcinoma is characterized by slow growth and relatively unaggressive behavior compared to other types of squamous cell carcinoma. Because it can mimic a benign condition, such as a wart, and it may initially be painless, verrucous squamous cell carcinoma can sometimes be mistaken for a less serious issue, leading to delayed diagnosis.

Verrucous squamous cell carcinoma diagnosis

If verrucous squamous cell carcinoma is suspected, a physician will typically perform a thorough clinical evaluation, including an examination of the affected area, a medical history review and a discussion about any symptoms, risk factors or changes in the appearance of the lesion.

Depending on the location and extent of the lesion, the physician may order imaging studies such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) scans to assess the size and depth of the tumor and determine if it has spread to nearby tissues or lymph nodes.

A definitive diagnosis of verrucous squamous cell carcinoma can be made based on the results of a biopsy. To evaluate an oral, genital or anal lesion, the physician will typically order an incisional biopsy, which involves removing a small portion of the lesion for analysis. In some cases, a punch biopsy or excisional biopsy may be performed, depending on the size and location of the lesion.

The biopsy sample will be sent to a pathologist, who will examine it under a microscope to look for characteristic features of verrucous squamous cell carcinoma, including the warty appearance of the tumor cells. This examination can confirm a diagnosis of verrucous squamous cell carcinoma.

Verrucous squamous cell carcinoma treatment

The optimal treatment approach for verrucous squamous cell carcinoma can vary depending on the location, size and extent of the tumor. Some common options include:

Wide local excision to remove the tumor along with a margin of healthy tissue
Mohs micrographic surgery to preserve the surrounding tissues when removing a tumor from a sensitive area, such as the face (Mohs surgery is offered in conjunction with the USF Department of Dermatology)
Lymph node dissection to remove cancerous lymph nodes
Radiation therapy as a standalone treatment if surgery is not possible or after surgery to help prevent a recurrence
Chemotherapy for an advanced or metastatic tumor

Benefit from world-class care at Moffitt Cancer Center/h2>

Moffitt is a high-volume cancer center, and the renowned team in our Cutaneous Oncology Program has extensive experience in diagnosing and treating all types of skin cancer, including verrucous squamous cell carcinoma and other uncommon variants. As the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, Moffitt is also a nationally recognized leader in cancer research. With a commitment to transforming our groundbreaking discoveries into tangible benefits for our patients as quickly as possible, we continue to achieve outcomes that exceed the national averages. We ensure that each patient has individualized care and the best possible quality of life.

You can request an appointment with a specialist in our Cutaneous Oncology Program without a referral. Call 1-888-663-3488 or submit a new patient registration form online.

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