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Return to: Laryngeal leukoplakia white plaques on vocal cords

Return to: Overview of squamous dysplasia

Verrucous carcinoma is a special variant of exceedingly well-differenatied squamous carcinoma that invades the submucosa along a broad, pushing front. It is important to recognize because in its pure form it does not metastasize. The lesion is composed of tall, hyperkeratotic papillary fronds lined by minimally atypical squamous cells; overt dysplasia is not seen. Mitoses are very rare or not identified. It is absolutely critical to examine the base of the lesion and junction of the lesion from the normal mucosa. If these lesions are superficially sampled at the time of laryngoscopy, the pathology report is usually returned with some form of "atypical verrucous proliferation" with a comment explaining that the entire lesion must be examined for definitive diagnosis. Thus, it behooves the head and neck surgeon to take a deep enough excision to include the base and the mucosal junction.

If conventional squamous carcinoma arises from verrucous carcinoma, the conventional lesion should drive surgical management and the metastatic potential mirrors that of conventional squamous carcinoma.

Gross inspection of the vocal cords shows an exophytic, friable white lesion on the right true vocal cord.	During the process of removal, white flakes of friable material litter the area. This material correlates with the extensive hyperkeratosis seen in verrucous carcinoma.	Abundant keratotic debris is evident.	Low power of vocal cord excision showing verrucous squamous carcinoma characterized by long papillae with dense hyperkeratosis and bulbous base (arrows) that invades along a broad front. Examination of the base of the lesion is essential.
One side of the carcinoma showing the junction of normal mucosa and tumor (black arrow) that bulges into the submucosa.	Opposite aspect of the tumor showing the bulbous, broadly invasive front (black arrow) juxtaposed to the normal mucosa.	High power examination of the tumor's invasive front showing extremely well-differentiated tumor cells with minimal cytologic atypia associated with a chronic inflammatory host response.