Verrucous Carcinoma of the Vulva

Summary and Comment |
March 15, 2016

Verrucous Carcinoma of the Vulva

  1. Angelica Selim, MD

Surgical excision is the treatment of choice for vVC.

  1. Angelica Selim, MD

Verrucous carcinoma, a variant of squamous cell carcinoma, is slow-growing but potentially locally destructive. Although most commonly found in the oropharynx, the ano-genital area is also frequently affected. Its relationship with human papilloma virus (HPV) is controversial.

A retrospective review at a tertiary healthcare center detected six stage I cases of vulvar verrucous carcinoma (vVC). Patients (mean age, 55) complained of exophytic masses on the right labia minora or majora associated with pain and pruritus. HPV testing performed in two cases was negative. Surgical excision with negative margins was the treatment of choice. Over a mean follow-up of ~18 months, no recurrence occurred. Of 61 cases reported in the same period in the medical literature, the recurrence rate ranged from 12.5% to 17.5%, and HPV testing demonstrated a few associations with HPV types 6 or 11.

Comment

vVCs represent fewer than 1% of vulvar cancers. These exophytic expanding tumors show a histologic verruciform growth pattern with blunt pushing interface between the neoplastic epithelium and the stroma and minimal nuclear atypia. As the architecture of this tumor is essential for diagnosis, a large representative sample should include the base of the tumor. No clear evidence shows an etiologic role for HPV. An HPV-related tumor that can be confused with vVC is giant condyloma acuminatum (aka Buschke-Loewenstein tumor), which includes koilocytes and thick fibrovascular cores throughout the lesion, not seen in vVC. Surgical excision is the treatment of choice for vVC, with node dissection for clinically positive nodes. Radiation can induce anaplastic transformation. The prognosis is relatively good, and overtreatment should be avoided.

Editor Disclosures at Time of Publication

  • Disclosures for Angelica Selim, MD at time of publication Grant / Research support NIH/NCI, The Plastic Surgery Foundation

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