25027 Treatment of epithelioma cuniculatum (plantar verrucous carcinoma): A systematic review of the literature

Abstract

Epithelioma cuniculatum (EC) is a subtype of verrucous carcinoma (VC) affecting the foot. Treatment involves complete tumor removal by wide local excision (WLE) or Mohs micrographic surgery (MMS), or amputation in extensive cases. We compared reported treatment methods for EC and determined their efficacy by assessing for tumor recurrence and treatment-associated complications. A systematic review of multiple databases was performed in accordance with PRISMA guidelines. 221 articles from the primary search and their references were screened. Ninety-six articles (115 cases) were included for final analysis. The majority of cases were treated with surgical therapy (91%). WLE was the most frequently reported treatment (58, 50%), with excision margins of 5 mm to 1 cm. Amputation was the second most common treatment modality (43, 38%), followed by MMS (14, 12%). Few reports used systemic therapy (acitretin and interferon-alpha), and other reported methods included imiquimod, electrodessication, curettage, debridement, and radiation. Recurrence rates were highest for WLE (33%), followed by MMS (17%), and amputation (10%). The relation between treatment modality and recurrence for WLE and amputation was significant (χ2 = 4.7, P = .03), but not for WLE and MMS (χ2 = .2, P = .28). Surgical excision is recommended as standard-of-care for the treatment of EC, with amputation considered in more advanced cases. Our review found that MMS is associated with lower recurrence rates than WLE for the treatment of EC. Further investigation of MMS for EC with appropriate follow-up is necessary to identify whether MMS is associated with lower recurrence and less functional impairment.