Introduction:
Verrucous carcinoma, often known as Ackerman's tumor, is a rare variant of squamous cell carcinoma characterized by slow growth and minimal metastatic potential despite its local aggressiveness. Diagnosis hinges upon clinical, macroscopic, and microscopic criteria, complicated by its benign histological appearance.
Observation:
A 70-year-old woman with a history of prolonged sun exposure presented with leukokeratoses involving the vermilion borders of both lips and the left labial commissure, accompanied by infiltrative lesions showing verrucous surfaces over a 3-year period. Initial histological examinations suggested papilloma altered by inflammation. Dermatological consultation and polarized dermoscopy revealed hairpin vessel-like structures, bright white features, and yellowish crusts. Subsequent guided biopsies confirmed extensive verrucous carcinoma upon histopathological evaluation.
Surgical excision encompassed the entire tumor involving the left half of both lips and the left labial commissure, followed by reconstruction using the "lip-shave" technique. Immediate postoperative findings demonstrated successful commissuroplasty. Complete excision with clear margins was achieved, and no recurrence or metastasis occurred during the 3-year follow-up.
Discussion:
Verrucous carcinoma, originally described by Ackerman, represents a distinct entity from conventional squamous cell carcinoma, with a favorable prognosis and minimal metastatic potential. Clinical diagnosis is challenging, often resembling benign papillomatous lesions histologically. Treatment typically involves surgical excision, with varying outcomes based on tumor extent.
Conclusion:
Buccal verrucous carcinoma poses diagnostic challenges, with divergent views on its classification relative to squamous cell carcinoma. Close collaboration with dermatologists is crucial for accurate diagnosis and management. Surgical excision remains the primary treatment modality, although its effectiveness diminishes in extensive cases.