Verrucous Carcinoma - Vulvar Cancers

Verrucous carcinoma of the vulva is a variant of epidermoid carcinoma. Clinically, it appears as large, condylomatous lesions. They are locally aggressive, nonmetastatic, fungating tumors that gradually increase in size, pushing into rather than invading the underlying structures. Histologically, they consist of mature squamous cells with extensive keratinization. To establish the diagnosis, adequate biopsy is important because biopsy of a large verrucous carcinoma often can lead to an incorrect diagnosis of condyloma acuminatum.

These tumors tend to grow slowly and invade locally, rarely spreading to regional lymph nodes. In 24 cases of verrucous carcinoma, Japaze and colleagues found no lymph node metastases.

Depending on the size and location of the tumor, a wide local excision or simple vulvectomy is effective therapy; radical vulvectomy with inguinal node dissection or radiation therapy is not indicated as treatment for this entity. Radiation therapy is ineffective and can even worsen the prognosis, causing malignant changes within the tumor.

The 17 cases treated surgically by Japaze and colleagues had an excellent 5-year survival rate of 94%. Close long-term follow-up is needed because disease can recur locally, especially if the tumor is large. If concurrent squamous cell carcinoma is found within the verrucous carcinoma, local excision is an inadequate therapy.

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