Verruocus Carcinoma - Clinical and histopathological features

VERRUCOUS CARCINOMA (SNUFF
DIPPER’S CANCER; ACKERMAN’S TUMOR):
Verrucous carcinoma is a low-grade variant of oral squamous
cell carcinoma. In 1948, Ackerman described this
lesion in detail, although the term verrucous carcinoma had
been used in 1944 in a series of cases reported by Burford,
Ackerman, and Robinson. Ackerman postulated that some
of these lesions might be associated with smokeless tobacco
use, because 11 of his 31 patients were “tobacco chewers.”
Verrucous carcinoma is found predominantly in men older
than 55 years (average age: 65 to 70 years). In areas where
women frequently use dry snuff, however, older females
may predominate. The most common sites of oral mucosal
involvement include the mandibular vestibule, buccal
mucosa, gingiva, tongue, and hard palate.
Verrucous carcinoma has a deceptively benign microscopic
appearance; it is characterized by wide and elongated rete
ridges that appear to “push” into the underlying connective tissue

1. VERRUCOUS CARCINOMA

DR DIVYA B
Department of Oral Pathology
& Microbiology
SRM Dental College,
Ramapuram, Chennai, India

2. VERRUCOUS CARCINOMA
•Low grade variant of squamous cell carcinoma
•Ackermann's tumor
•Snuff dipper's cancer
Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai, India

3. CLINICAL FEATURES
Exophytic, papillary
pebbly surface
rugae-like folds with deep
clefts
•Mucosal membrane - oral cavity, larynx
•Site - buccal mucosa, gingiva or alveolar ridge
•Male predilection
•6th - 7 th decade
•Tobacco
Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai, India

4. CLINICAL FEATURES
•Involvement of deeper
contiguous structures
•Regional lymph nodes –tender,
enlarged
•SYMPTOMS -Pain and
difficulty in mastication
Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai, India

5. HP FEATURES
Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai, India

6. HP FEATURES
•Epithelium - Well Differentiated
•Shows little mitotic activity,
pleomorphism, or hyperchromatism.
Basement membrane intact
Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai, India

7. HP FEATURES
PARAKERATIN LINING THE CLEFTS
WITH PARAKERATIN PLUGGING
Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai, India

8. DISTINGUISHING FEATURES
FEATURES VERRUCOUS CARCINOMA OSCC
Mode of growth Slow Rapid
Metastatic potentialLow High
Prognosis Better poor
Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai, India

9. TREATMENT
•Conservative excision
•Patients treated by ionizing radiation -anaplastic transformation
of lesions
Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai, India

10. THANK YOU
Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai, India