From the Section of Plastic Surgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.
Ann Plast Surg. 2024 Sep 1;93(3):369-373. doi: 10.1097/SAP.0000000000004081.
Verrucous carcinoma (VC) was first described in 1948 by Dr. Ackerman. It is a low-grade cutaneous squamous carcinoma that usually develops in the oral cavity, the anogenital region, and the plantar surface of the foot. Clinically, there is low suspicion for malignancy given the slow growth of VC lesions and their wart-like appearance. Diagnosis can be difficult because of the benign histological appearance with well-differentiated cells and absence of dysplasia. Surgical excision is the only satisfactory form of treatment for plantar VC; however, this becomes difficult given its benign clinical appearance and the pathologic misinterpretation of the lesion as a benign hyperplasia. While there are case reports and retrospective studies of patients with plantar VC in the literature, we present the largest case series of plantar VC within North America, with recurrence despite negative margins.
We report on all the plantar VC excised between 2014-2023. We report six cases of VC, their treatment, and their outcomes.
Six patients obtained a diagnosis of plantar VC by incisional biopsy. All patients underwent excision of their lesions and had negative margins reported on the final pathology. All patients developed nonhealing wounds at the site of their lesion excision; therefore, biopsies were performed to confirm a recurrence. All patients had a recurrence of VC at the initial site. All patients underwent re-excision of the lesions. Despite negative margins again on final pathology, all patients had a subsequent second recurrence. Ultimately, all patients underwent an amputation as definitive management. Each patient had an average of 3 operations. There were 4 different surgeons and different pathologists reporting their findings.
Our experience with plantar VC suggests that an aggressive approach to surgical management is needed. Furthermore, management is optimized with the combined expertise of an experienced dermatopathologist and surgeon. Despite negative margins and repeated excisions, VC lesions recur and invade local tissues to the extent that only amputation of the involved foot has resulted in cure.
疣状癌（VC）于 1948 年由阿克曼博士首次描述。它是一种低级别皮肤鳞状细胞癌，通常发生在口腔、肛门生殖器区域和足底表面。临床上，由于 VC 病变的生长缓慢及其疣状外观，对恶性肿瘤的怀疑程度较低。由于良性的组织学外观、分化良好的细胞和无发育不良，诊断可能具有挑战性。手术切除是治疗足底 VC 的唯一满意形式；然而，由于其良性的临床外观和病理上对病变的错误解释为良性增生，这变得很困难。虽然文献中有关于足底 VC 的病例报告和回顾性研究，但我们报告了北美最大的一组足底 VC 病例系列，尽管切缘阴性仍有复发。
我们报告了 2014 年至 2023 年间切除的所有足底 VC。我们报告了 6 例 VC 的病例，其治疗方法和结果。
6 名患者通过切开活检确诊为足底 VC。所有患者均接受了病变切除术，最终病理学报告切缘阴性。所有患者在病变切除部位均出现无法愈合的伤口；因此，进行了活检以确认复发。所有患者均在初始部位复发 VC。所有患者均再次切除病变。尽管最终病理学报告再次切缘阴性，但所有患者随后均再次复发。最终，所有患者均接受了截肢作为确定性治疗。每位患者的平均手术次数为 3 次。有 4 位不同的外科医生和不同的病理学家报告了他们的发现。
我们对足底 VC 的经验表明，需要采取积极的手术治疗方法。此外，通过经验丰富的皮肤科病理学家和外科医生的联合专业知识，可优化管理。尽管切缘阴性且反复切除，VC 病变仍会复发并侵犯局部组织，以至于只有截肢受累足才能治愈。
