Verrucous carcinoma of the axilla: case report and review

Cutaneous Verrucous Carcinomas: A Review

Verrucous carcinoma (VC) is a relatively rare locally aggressive, slow-growing, well-differentiated squamous cell carcinoma with minimal metastatic potential and is most frequent in the mucosa. Although rarely reported on the skin, cutaneous verrucous carcinomas (CVC) can appear anywhere, most commonly on the feet. However, clinical and pathologic diagnosis of CVC has been confusing and challenging. It can easily be mistaken for benign or more malignant conditions such as giant condyloma acuminata, keratoacanthoma, and pseudoepithelioma-like hyperplasia or squamous cell carcinoma, resulting in inappropriate management. In this review, we describe the different aspects associated with CVC, including its pathogenesis and clinicopathologic features. The available evidence for the differential diagnosis and treatment of CVC is discussed, and specific management recommendations are made. After the treatment, careful follow-up examinations of the excised area should be performed at regular intervals.

Cutaneous verrucous carcinoma: A clinicopathological study of 21 cases with long-term clinical follow-up

BACKGROUND

Cutaneous verrucous carcinoma (CVC) is a rare variant of squamous cell carcinoma and sometimes shares similar clinical and histopathological features with other verrucous lesions.

METHODS

We performed a retrospective study of 21 patients diagnosed with CVC between 2012 and 2022 by reviewing clinical and histopathological data. We also compared the clinicopathological features of patients with CVC, giant condyloma acuminatum (GCA), and pseudoepitheliomatous hyperplasia (PEH). We obtained follow-up data by reviewing medical records and telephone interviews.

RESULTS

The average age of patients with CVC was 63.6 years, with a male predominance. The location of disease is mostly found in the foot, followed by the lower legs. Histologically, CVC is characterized by an exo-endophytic growth pattern with severe keratinization and a blunted rete ridge with pushing margins. Clinical features including exudation and crusting, induration, irregular borders, and warty surface, as well as pathological features including growth pattern, koilocytotic cells, depth and morphologic features of acanthosis, severe keratinization, and degree of dermal inflammation, were significant in distinguishing cutaneous CVC, GCA, and PEH.

CONCLUSION

Identification of the clinicopathological features is essential to distinguish CVC from its mimics and to make an early diagnosis. Because of the potential for recurrence and metastasis, CVC requires aggressive treatment.

Long-term efficacy and safety of ustekinumab for moderate-to-severe psoriasis: A 9-year real-life experience from a tertiary referral center in Turkey

There is a paucity of data on long-term (≥5-year) outcomes of ustekinumab therapy for psoriasis in real-life clinical practice. This observational, retrospective study aimed to evaluate the long-term efficacy and safety profile of ustekinumab in 52 adult patients with moderate-to-severe chronic plaque psoriasis who were treated with ustekinumab for at least 28 weeks and a maximum of 105 months in our tertiary referral center in Turkey, between 2010 and 2019. Response to therapy was assessed using Psoriasis Area and Severity Index (PASI). Logistic regression analysis was performed to determine significant associations (p-value <0.05) with response to treatment. The PASI50, PASI75, PASI90, and PASI100 response rates were 97.8%, 88.9%, 53.3%, and 35.5%, respectively, at year 1 and 100%, 80.0%, 60.0%, and 40.0%, respectively, at year 5. Non-obesity was independently associated with PASI90 response at year 2 (p = 0.043), while biologic-naivety was independently associated with PASI90 responses at year 2 (p = 0.047) and year 3 (p = 0.021). An absolute PASI score of ≤3 was achieved by 82.2% and 80.0% of the patients at year 1 and year 5, respectively. Nine patients received adjuvant therapy and nine underwent ustekinumab dose escalation. These strategies were effective for recapturing clinical response in most patients. Ustekinumab was generally well-tolerated with no dose-related and cumulative toxicity, or drug interaction over a mean of 33.5 ± 21.1 months. The main reasons for discontinuation were secondary failure and loss to follow-up. Our 9-year real-life clinical experience demonstrates that ustekinumab is an efficacious and safe treatment option for long-term therapy of moderate-to-severe plaque psoriasis.

Lesions With an Epidermal Hyperplastic Pattern: Morphologic Clues in the Differential Diagnosis

In this report, we review the most common entities that show a epidermal hyperplastic pattern in the biopsy. These entities include inflammatory, reactive, infectious, hamartomatous, and tumoral conditions, each with a very different prognosis. Therefore, an approach based on the classic "patterns and clues" tools used in dermatopathology can bring a lot of information to the dermatopathologist or the general pathologist evaluating these lesions.

Immunohistochemical findings and differential diagnosis of papillary-type cutaneous verrucous carcinoma of the neck: A case report

Verrucous carcinoma (VC) is a rare subtype of squamous cell carcinoma, with the majority of cases occurring in the oral cavity and genital area. The present study describes a rare case of cutaneous VC of the neck manifesting as a semi-pedunculated multinodular protrusion. Histological analysis revealed thickening of the epidermis and papillary growth. Although cellular atypia was generally mild, a large number of mitoses were observed, of which a small number were abnormal. Additionally, bulbous subepidermal invasion was observed. The lesion was differentiated from papillary squamous cell carcinoma, another rare subtype of squamous cell carcinoma, based on the presence of epidermal verrucous growth and the lack of remarkable nuclear atypia. Benign disorders, including seborrheic keratosis, fibroepithelial polyp, verruca vulgaris and pseudocarcinomatous hyperplasia, were also differentiated from the lesion. Immunohistochemical analysis of cytokeratin (CK)10 expression revealed attenuated staining of the lesion, therefore, anti-CK10 immunohistochemistry may be valuable in the diagnosis of VC.

Verrucous carcinoma of the foot: a case report

We present a case of verrucous carcinoma of the foot in a 34-year-old man. This is a rare, locally invasive, well-differentiated, low-grade squamous cell carcinoma, with human papilloma virus as a possible causative agent. It follows a chronic course and mimics a variety of skin lesions, delaying diagnosis by up to 15 years. The definitive diagnosis is made histologically, and treatment by wide local excision is recommended. Our patient underwent wide local excision and partial 5th metatarsal amputation because of invasive disease, local infection, and peripheral vascular disease. There were no postoperative complications. At the 10-year follow-up, there were no signs of tumour recurrence.

Photodynamic therapy for cutaneous verrucous carcinoma

Cutaneous verrucous carcinoma is a low-grade and well-differentiated variant of squamous cell carcinoma. This rare neoplasm follows a seemingly indolent progression and exhibits a low metastatic potential. Photodynamic therapy relies on the selective intratumoral cell accumulation and photoactivation of a photosensitizer, leading to the generation of phototoxic compounds responsible for necrosis and apoptosis of the target cells. An 82-year-old man presenting with a large long-standing verrucous carcinoma on the leg was treated successfully by 6 photodynamic therapy sessions administered at weekly intervals using methyl-aminolevulinate and 57-J/cm(2) irradiations at 634-nm wavelength. The use of methyl-aminolevulinate-photodynamic therapy for treating cutaneous verrucous carcinoma had not been reported so far. It may represent a convenient therapeutic alternative in this setting.

Verrucous Carcinoma of the Scalp Associated with Human Papillomavirus Type 33

BACKGROUND

Verrucous carcinoma (VC) is a low-grade, well-differentiated squamous cell carcinoma of the skin or mucosae, and human papillomavirus (HPV) infection has been considered to be one of the causative factors of VC at three main sites, including the oral cavity, the genitoanal region, and the foot. However, the relationship between cutaneous VC at other sites and HPV infection remains obscure.

OBJECTIVE

We describe a rare case of cutaneous VC originating in a burn scar on the scalp and our attempt to find HPV infection in the lesion.

METHODS

We investigated the presence of HPV by polymerase chain reaction-restriction fragment length polymorphisms and immunohistochemical analysis.

RESULTS

HPV type 33 was detected in the lesion, and positive stains for HPV were observed in several cell nuclei at the upper stratum malpighi.

CONCLUSION

Since HPV type 33, as well as HPV types 16 and 18, is regarded as a high-risk, mucosal type, HPV type 33 infection likely contributed to the development of the lesion. We suggest that HPV infection should be relevant to a subset of cutaneous VC.