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Boettler MA, Gray AN, Brodsky MA, Shahwan KT, Carr DR. Mohs micrographic surgery for verrucous carcinoma: a review of the literature. Arch Dermatol Res 2023; 315:133-137. [PMID: 36112206 DOI: 10.1007/s00403-022-02396-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 06/29/2022] [Accepted: 09/07/2022] [Indexed: 11/25/2022]
Abstract
Verrucous carcinoma is a rare, low grade variant of squamous cell carcinoma that rarely metastasizes but tends to display aggressive local behavior. Wide local excision is the most common treatment, but has high rates of local recurrence, ranging from 19 to 75% in the literature. The cases of verrucous carcinoma treated with Mohs micrographic surgery in the literature, as well as a previously unpublished case is summarized. PubMed was searched for terms related to verrucous carcinoma and Mohs micrographic surgery, and articles reporting cases of verrucous carcinoma treated with Mohs were reviewed and summarized. A previously unpublished case treated at our institution was also reported. Thirty-eight cases of verrucous carcinoma treated with Mohs surgery were analyzed. The average age of patients was 52.1, and 50% were male. The most common sites were the foot (47%) and the anogenital region (34%). Lesion duration ranged from 0.17 to 40 years with a mean of 4.8 years, and tumor diameter ranged from 1 to 10 cm with a mean of 4.6 cm. The local recurrence rate following Mohs was 16%, with nodal metastasis occurring in 3% and no cases of distant metastasis. As verrucous carcinoma demonstrates locally aggressive behavior and a high risk of local recurrence, Mohs micrographic surgery should be considered as first line treatment. Further research directly comparing wide local excision to Mohs surgery is needed.
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Affiliation(s)
| | - Ashley N Gray
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Merrick A Brodsky
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kathryn T Shahwan
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Altru Health System/University of North Dakota Medical School, Grand Forks, ND, USA.
| | - David R Carr
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Fawaz B, Vieira C, Decker A, Lawrence N. Surgical treatment of verrucous carcinoma: a review. J DERMATOL TREAT 2021; 33:1811-1815. [PMID: 33849379 DOI: 10.1080/09546634.2021.1914312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Verrucous carcinoma is a rare mucocutaneous malignancy characterized by slow, relentless growth and a low metastasis rate. OBJECTIVE Herein we summarize surgical success rates and review newer approaches to the treatment of verrucous carcinomas.Methods & Materials: PubMed electronic searches were performed by B.F. and C.V. using combinations of the following terms: ''verrucous carcinoma,'' ''Ackerman tumor,'' ''Buschke Lowenstein,'' ''epithelioma cuniculatum,'' ''carcinoma cuniculatum,'' ''papillomatosis cutis,'' ''treatment,'' ''therapeutics,'' ''management,'' ''mohs surgery,'' and ''excision.'' A systematic review was conducted on 49 articles in accordance with PRISMA guidelines. RESULTS Surgical management remains first-line therapy. Wide local excision is most commonly utilized, with highly variable margins (0.5-3.0 cm) and recurrence rates (4.6-75.0%). Mohs Micrographic Surgery has also been used, especially for recurrent tumors, with an overall recurrence rate of 12.9%. CONCLUSION Surgery is the treatment of choice, either by Mohs Micrographic Surgery or wide local excision. However, surgical recurrence rates are high, and tissue-sparing therapies are desirable given the sensitive locations involved. Ultimately, randomized control trials are needed to develop evidence-based guidelines for the management of VCs.
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Affiliation(s)
- Bilal Fawaz
- Cooper Center for Dermatologic Surgery, Evesham, NJ
| | - Carlos Vieira
- Cooper Medical School of Rowan University, Camden, NJ
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Deshpande D, Agarwal N, Fleming T, Gaveriaux-Ruff C, Klose CSN, Tappe-Theodor A, Kuner R, Nawroth P. Loss of POMC-mediated antinociception contributes to painful diabetic neuropathy. Nat Commun 2021; 12:426. [PMID: 33462216 PMCID: PMC7814083 DOI: 10.1038/s41467-020-20677-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/10/2020] [Indexed: 02/06/2023] Open
Abstract
Painful neuropathy is a frequent complication in diabetes. Proopiomelanocortin (POMC) is an endogenous opioid precursor peptide, which plays a protective role against pain. Here, we report dysfunctional POMC-mediated antinociception in sensory neurons in diabetes. In streptozotocin-induced diabetic mice the Pomc promoter is repressed due to increased binding of NF-kB p50 subunit, leading to a loss in basal POMC level in peripheral nerves. Decreased POMC levels are also observed in peripheral nervous system tissue from diabetic patients. The antinociceptive pathway mediated by POMC is further impaired due to lysosomal degradation of μ-opioid receptor (MOR). Importantly, the neuropathic phenotype of the diabetic mice is rescued upon viral overexpression of POMC and MOR in the sensory ganglia. This study identifies an antinociceptive mechanism in the sensory ganglia that paves a way for a potential therapy for diabetic neuropathic pain.
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Affiliation(s)
- Divija Deshpande
- grid.5253.10000 0001 0328 4908Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, INF 410 Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Institute of Pharmacology, Heidelberg University, INF 366, Heidelberg, 69120 Germany ,grid.6363.00000 0001 2218 4662Department of Microbiology, Infectious Diseases and Immunology, Charité -Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Nitin Agarwal
- grid.7700.00000 0001 2190 4373Institute of Pharmacology, Heidelberg University, INF 366, Heidelberg, 69120 Germany
| | - Thomas Fleming
- grid.5253.10000 0001 0328 4908Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, INF 410 Heidelberg, Germany ,grid.452622.5German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Claire Gaveriaux-Ruff
- grid.420255.40000 0004 0638 2716Institut de Génétique et de Biologie Moléculaire et Cellulaire, Department of Translational Medicine and Neurogenetics, Illkirch, France ,grid.420255.40000 0004 0638 2716Université de Strasbourg, Illkirch, France ,grid.4444.00000 0001 2112 9282Centre National de la Recherche Scientifique, UMR7104 Illkirch, France ,Institut National de la Santé et de la Recherche Médicale, U1258 Illkirch, France ,grid.418692.00000 0004 0610 0264Ecole Supérieure de Biotechnologie de Strasbourg, Illkirch, France
| | - Christoph S. N. Klose
- grid.6363.00000 0001 2218 4662Department of Microbiology, Infectious Diseases and Immunology, Charité -Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Anke Tappe-Theodor
- grid.7700.00000 0001 2190 4373Institute of Pharmacology, Heidelberg University, INF 366, Heidelberg, 69120 Germany
| | - Rohini Kuner
- grid.7700.00000 0001 2190 4373Institute of Pharmacology, Heidelberg University, INF 366, Heidelberg, 69120 Germany
| | - Peter Nawroth
- grid.5253.10000 0001 0328 4908Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, INF 410 Heidelberg, Germany ,grid.452622.5German Center for Diabetes Research (DZD), Neuherberg, Germany ,Joint Heidelberg-IDC Translational Diabetes Program, Helmholtz Zentrum, 85764 Neuherberg, Germany
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Mistaken Diabetic Ulcers: A Case of Bilateral Foot Verrucous Carcinoma. Case Rep Dermatol Med 2018; 2018:4192657. [PMID: 29796321 PMCID: PMC5896404 DOI: 10.1155/2018/4192657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/20/2017] [Indexed: 11/18/2022] Open
Abstract
Verrucous carcinoma (VC) is a rare, low-grade, and well-differentiated variant of squamous cell carcinoma. These tumors are slow-growing and exophytic and have a negligible incidence of metastasis. Treatment is complete surgical resection, ideally by Mohs micrographic surgery, to ensure adequate clear margins. Cutaneous VC predominantly occurs on the plantar surface of the foot and rarely occurs in multiple sites. This case study describes the fourth reported occurrence of bilateral VC of the feet in a woman with chronic diabetic foot ulcers. The case provides further support for persistent wounds contributing to the development of this lesion and describes their role in the characteristic delay in diagnosis of VC.
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Nagarajan D, Chandrasekhar M, Jebakumar J, Menon KA. Verrucous carcinoma of foot at an unusual site: Lessons to be learnt. South Asian J Cancer 2017; 6:63. [PMID: 28702408 PMCID: PMC5506811 DOI: 10.4103/2278-330x.208839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- D Nagarajan
- Department of General Surgery, Stanley Medical College, Chennai, Tamil Nadu, India
| | | | - Jim Jebakumar
- Department of General Surgery, Stanley Medical College, Chennai, Tamil Nadu, India
| | - K Aravind Menon
- Department of General Surgery, Stanley Medical College, Chennai, Tamil Nadu, India
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Narayana GP, Sandhya I. Verrucous carcinoma of the finger: A rare site of occurrence. Indian Dermatol Online J 2014; 5:218-9. [PMID: 24860768 PMCID: PMC4030361 DOI: 10.4103/2229-5178.131133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - I Sandhya
- Department of Pathology, AJIMS, Mangalore, Karnataka, India
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El Ouazzani A, Ellouadghiri A, Saidi A, Senouci K, Hassam B. [Subungual verrucous carcinoma]. Ann Dermatol Venereol 2014; 141:83-4. [PMID: 24461104 DOI: 10.1016/j.annder.2013.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 07/17/2013] [Accepted: 08/12/2013] [Indexed: 11/17/2022]
Affiliation(s)
- A El Ouazzani
- Service de dermatologie vénérologie, faculté de médecine et de pharmacie, université Mohamed V, CHU Ibn Sina, avenue Ahmed-Balafrej, 10000 Rabat, Maroc.
| | - A Ellouadghiri
- Service de dermatologie vénérologie, faculté de médecine et de pharmacie, université Mohamed V, CHU Ibn Sina, avenue Ahmed-Balafrej, 10000 Rabat, Maroc
| | - A Saidi
- Centre d'anatomie pathologique, les Nations Unies, angle avenue des Nation Unies, rue Ibn Hanbal Agdal, Rabat, Maroc
| | - K Senouci
- Service de dermatologie vénérologie, faculté de médecine et de pharmacie, université Mohamed V, CHU Ibn Sina, avenue Ahmed-Balafrej, 10000 Rabat, Maroc
| | - B Hassam
- Service de dermatologie vénérologie, faculté de médecine et de pharmacie, université Mohamed V, CHU Ibn Sina, avenue Ahmed-Balafrej, 10000 Rabat, Maroc
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Suen K, Wijeratne S, Patrikios J. An unusual case of bilateral verrucous carcinoma of the foot (epithelioma cuniculatum). J Surg Case Rep 2012; 2012:rjs020. [PMID: 24968418 PMCID: PMC3855215 DOI: 10.1093/jscr/rjs020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Verrucous carcinoma is a rare, well-differentiated variant of squamous cell carcinoma with a minimal incidence of metastasis. Conservative treatment and local excision have been utilized although with high recurrence rates. We present a unique case of a 44-year-old male with bilateral foot involvement with recurrences after local excision, leading to management with bilateral forefoot amputations.
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Affiliation(s)
- Kary Suen
- Department of Surgery, Wimmera Base Hospital, Horsham, Vic., Australia
| | - Shiran Wijeratne
- Department of Surgery, Wimmera Base Hospital, Horsham, Vic., Australia
| | - John Patrikios
- Department of Surgery, Wimmera Base Hospital, Horsham, Vic., Australia
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Abstract
Verrucous carcinoma (VC) of the nail bed and matrix is a rare malignancy that is often misdiagnosed as a benign condition. We present a case of a 65-year-old woman with a 2-year history of a progressive right fourth fingernail verrucous plaque replacing and surrounding her entire fourth fingernail. Diagnosis of VC was confirmed by a longitudinal biopsy and patient underwent en bloc excision and skin graft placement. The patient remained disease free with acceptable function of the digit at 24 months of follow-up. Although uncommon, VC must be considered in all patients with a persistent and enlarging verrucous lesion involving the nail apparatus. Preoperative evaluation must include an adequate biopsy specimen to avoid misdiagnosis of verruca vulgaris. Digital radiographs are recommended to evaluate local invasion to bone.
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Affiliation(s)
- Yuta Kurashige
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan.
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Abstract
BACKGROUND Verrucous carcinoma is a well-differentiated variant of squamous cell carcinoma seen on mucosa and skin, including the hands. METHODS We report the case of a large verrucous carcinoma of the right palm which was completely resected with a fourth ray resection and remained without evidence of tumor recurrence or metastatic disease during follow-up for 11 years. On this basis, we reviewed all 15 previously published cases of verrucous carcinoma of the hand to define the peculiarities of this uncommon tumor and to give diagnostic and therapeutic recommendations. RESULTS Verrucous carcinoma is defined by its characteristic clinical presentation as slowly but relentlessly enlarging "wart-like" tumor, by the typical histologic finding of local invasion with only minimal, if any, dysplasia and by the unique biological behavior with low incidence of metastases and good prognosis. For proper diagnosis, both careful physical examination and deep surgical biopsy must be performed. Radical resection is the treatment of choice with histologically confirmed tumor-free resection margins. Lymphadenectomy should only be performed in case of suspicious lymphadenopathy. CONCLUSIONS Verrucous carcinoma may present a difficult diagnostic problem. After complete surgical resection, it has a good prognosis.
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Affiliation(s)
- Ralf Gertler
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. . tu-muenchen.de
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Carcinoma cuniculatum of the larynx: a rare clinicopathological entity. The Journal of Laryngology & Otology 2007; 122:1118-23. [DOI: 10.1017/s0022215107000163] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractObjective:Carcinoma cuniculatum is a rare variant of low-grade squamous cell carcinoma. We report the second case of carcinoma cuniculatum of the larynx in the literature.Method:Case report and review of the world literature concerning carcinoma cuniculatum of the larynx and upper aerodigestive tract.Results:A histologically proven carcinoma cuniculatum of the larynx is reported in a 72-year-old man. The patient underwent a supracricoid laryngectomy with crico-hyoidopexy, and was free of disease at 70 months after surgery. We emphasise the clinical presentation, histology and therapeutic approach of this rare tumour.Conclusion:To our knowledge this is the second report in the world literature of carcinoma cuniculatum of the larynx. Carcinoma cuniculatum of the larynx must be considered as a distinct ‘clinicopathological entity’ and close cooperation between the clinician and the pathologist is essential for the correct diagnosis of these tumour as regards to the correct classification and therapy.
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Barreto JE, Velazquez EF, Ayala E, Torres J, Cubilla AL. Carcinoma Cuniculatum: A Distinctive Variant of Penile Squamous Cell Carcinoma. Am J Surg Pathol 2007; 31:71-5. [PMID: 17197921 DOI: 10.1097/01.pas.0000213401.72569.22] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We are reporting a peculiar variant of penile squamous cell carcinoma (SCC) characterized by its peculiar deeply penetrating and burrowing pattern of growth. This low grade, verruciform penile neoplasm is similar to the plantar epithelioma cuniculatum originally described by Ayrd in 1954. Clinical and pathologic features of 7 patients are presented. There were 7 partial penectomies and 4 bilateral inguinal node dissections. The mean patient's age was 77 years. Grossly, the tumors were white to gray, exo-endophytic, and papillomatous with a cobblestone or spiky appearance. All cases affected the glans and extended to coronal sulcus and foreskin (average size was 6.3 cm). The hallmark of the lesion was noted on cut surface where there were deep tumoral invaginations forming irregular, narrow, and elongated neoplastic sinus tracts connecting the surface of the neoplasm to deep anatomic structures. The neoplasm invaded through lamina propria and corpus spongiosum and grew along the loose connective tissue of Buck fascia to involve the tunica albuginea and corpora cavernosa (average depth was 32 mm). Deeply invasive keratin filled cysts or crypts, on serial sections, showed to be connected to the surface tumor. Fistulization to the skin was also noted. Microscopically, the lesions corresponded to well-differentiated carcinomas with bulbous front of invasion. There were focal areas of higher histologic grade and more infiltrative and jagged borders in 4 cases. Inguinal nodes were negative in 4 patients in which groin dissection was performed. Carcinoma cuniculatum is a variant of penile SCC with distinctive growth pattern and should be distinguished from other verruciform tumors such as the verrucous, papillary, and warty carcinomas. Unlike most subtypes of penile SCCs and despite the deep invasion, none of the tumors showed groin or systemic dissemination at time of diagnosis.
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Affiliation(s)
- José E Barreto
- Instituto de Patología e Investigación and Facultad de Ciencias Médicas, Universidad Nacional de Asuncion, Asunción, Paraguay
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Abstract
Professor Ian Aird, a renowned British surgeon of the mid-twentieth century, described a peculiar neoplasm of the foot in 3 patients under the term epithelioma cuniculatum, now more commonly called carcinoma cuniculatum. I will recount the life of Professor Aird and then summarize his original report emphasizing the clinical and more particularly the histopathologic criteria of epithelioma cuniculatum as described by Aird et al. Then I will summarize some of the subsequent reports of epithelioma (carcinoma) cuniculatum. Authors have grouped carcinoma cuniculatum with giant condyloma of the penis of Buschke-Loewenstein and oral verrucous carcinoma of Ackerman and similar neoplasms at other sites under the generic title "verrucous carcinoma." Although this classification has been accepted, I will stress that the clinical picture and histopathology described by Aird et al differ from those in later reports of carcinoma cuniculatum. These correspond to descriptions of the verrucous carcinomas of Buschke-Loewenstein and Ackerman. Finally, I will conclude that carcinoma cuniculatum as delineated by Aird and his colleagues is an extremely rare, indolent, nonmetastasizing squamous cell carcinoma composed of banal keratinocytes with unique clinical and histopathologic features that almost always arises on the foot. If a neoplasm on the foot has the characteristics of verrucous carcinoma that occurs at others sites, but not those of Aird et al, it should be called verrucous carcinoma of the foot, and not "epithelioma (carcinoma) cuniculatum."
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Sheen MC, Sheen YS, Sheu HM, Wong TW, Lee YY, Wu CF, Wang YW, Chai CY. Subungual Verrucous Carcinoma of the Thumb Treated by Intra-arterial Infusion with Methotrexate. Dermatol Surg 2006. [DOI: 10.1111/j.1524-4725.2005.31713] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Allon D, Kaplan I, Manor R, Calderon S. Carcinoma cuniculatum of the jaw: a rare variant of oral carcinoma. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 94:601-8. [PMID: 12424455 DOI: 10.1067/moe.2002.126913] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Carcinoma cuniculatum is a rare variant of carcinoma usually involving the foot. Only 13 cases have been described in the oral cavity, none of which was in the English-language literature. We describe a 56-year-old man who presented with a soft exophytic mass in the maxillary gingiva, alveolar bone destruction, and loosening of the teeth. Histopathologic study revealed thin papillary projections covered by a thick keratin layer in the superficial areas and multiple, branching keratin-filled crypts surrounded by well-differentiated squamous epithelium with only mild cytologic atypia but frequent mitosis. Immunohistochemistry results of p53 and polymerase chain reaction analyses for human papillomavirus 6, 11, 16, and 18 DNA were negative. The diagnosis was carcinoma cuniculatum of the jaw. The literature on this unusual oral pathosis is reviewed and the diagnostic challenge described. We suggest that carcinoma cuniculatum may sometimes be misdiagnosed as squamous cell carcinoma or verrucous carcinoma and, therefore, might be more prevalent than the small number of published cases implies.
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Affiliation(s)
- Dror Allon
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petah, Tikva, Israel.
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Abstract
Cutaneous squamous cell carcinomas (SCC) are one of the most common malignancies, which, with early recognition, may be curable. These tumors represent a broad spectrum of disorders with many significant clinical, morphologic, and etiologic distinctions. The objective of this article is to review the important clinicopathologic features of SCC with particular emphasis on important recent developments, practical application, and their relevance to the practice of pathology. The most pertinent literature of the last 5 years was reviewed and capsulized. Appropriate histologic interpretation and clinical management of patients with cutaneous SCC requires a comprehensive understanding of the latest advances in the broad field of dermatopathology. Squamous cell carcinoma of the skin represents a complex group of disease subtypes, each with its own characteristics, which may influence morphologic diagnosis as well as treatment and clinical management.
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Affiliation(s)
- C M Lohmann
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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18
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Abstract
The concept of verrucous carcinoma as a clinicopathologic variant of squamous cell carcinoma is worthy of recognition. It is known by a confusing array of names, such as Ackerman's tumor, Buschke-Loewenstein tumor, florid oral papillomatosis, epithelioma cuniculatum, carcinoma cuniculatum, and cutis papillomatosis carcinoides of Gottron. Its apparent clinical benignity may lead to lengthy periods of misdiagnosis, during which it is likely not to spread to distant lymph nodes, but rather to destroy a nose, mandible, or penis as it slowly but relentlessly extends into underlying tissue. Morphologically warty or verrucous, its relatively bland histologic features are often more suggestive of a verruca vulgaris or pseudoepitheliomatous hyperplasia than of squamous cell carcinoma to those unfamiliar with the diagnosis. Alternatively, when it extends into underlying tissues, it may be mistaken histologically for a benign adnexal tumor or even an epidermoid cyst. Therapy may also be challenging because recurrences are common and concerns about potential anaplastic transformation after radiotherapy are often expressed.
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Roenigk RK, Roenigk HH. Current surgical management of skin cancer in dermatology. THE JOURNAL OF DERMATOLOGIC SURGERY AND ONCOLOGY 1990; 16:136-51. [PMID: 2406310 DOI: 10.1111/j.1524-4725.1990.tb00034.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Skin cancer has become a major public health problem in the United States and worldwide. Epidemiologic studies confirm a continued increase in the number of basal cell carcinomas, squamous cell carcinomas, and malignant melanomas. Dermatologists, the primary caretakers of the skin, manage skin cancer with various modalities that have been time tested and found reliable, including excision, electrosurgery, cryosurgery, and Mohs micrographic surgery. Extirpative procedures for basal cell carcinoma and squamous cell carcinoma are considered with attention to cure, restoration of function, and cosmesis--in that order. The dermatologic management of melanoma is critical because early diagnosis and treatment of thin lesions has been the only effective improvement in melanoma management in the last several decades. Wide excision, with a 1-3-cm margin, of thin stage I melanoma has moved surgical management from the operating room to the outpatient surgical setting. Management of these increasingly common problems, as reviewed here, is principally responsible for the growth of surgical practice as a subspecialty of dermatology.
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Affiliation(s)
- R K Roenigk
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905
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Knobler RM, Schneider S, Neumann RA, Bodemer W, Radlwimmer B, Aberer E, Söltz-Szöts J, Gebhart W. DNA dot-blot hybridization implicates human papillomavirus type 11-DNA in epithelioma cuniculatum. J Med Virol 1989; 29:33-7. [PMID: 2555444 DOI: 10.1002/jmv.1890290107] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Epithelioma cuniculatum is a rare, low-grade squamous cell carcinoma, belonging to the group of verrucous carcinomas. Evidence is presented that suggests that human papilloma virus type-11 may be involved in the pathogenesis of epithelioma cuniculatum. HPV-DNA was detected by dot-blot hybridization with 32P-labelled probe DNA. Plasmids containing HPV-DNA were isolated by the benzoylated naphthoylated DEAE cellulose method (BND-method), an improved procedure for routine detection of HPV-DNA.
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Affiliation(s)
- R M Knobler
- Department of Dermatology II, University of Vienna, Austria
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