ORAL VERRUCOUS LESIONS—A DIAGNOSTIC DILEMMA: A 10-YEAR INSTITUTIONAL EXPERIENCE AND LITERATURE REVIEW

Abstract

Background Oral verrucous-papillary lesions (including proliferative verrucous leukoplakia) with malignant/frankly malignant potential are assigned diverse terminology resulting from lack of standard clinical and histologic diagnostic criteria, with implications for management. Objective To review the range of terminology employed at one institution in diagnosing verrucous-papillary lesions of the oral cavity. Methods A single institution's archives were searched for oral cases diagnosed as verrucous, verruciform, verrucoid, or squamoproliferative over a 10-year period (2010-2020). Results One hundred eighty-one specimens from 146 cases were identified; 69 were female (47%), 77 were male (53%), and 101 cases were diagnosed in the sixth to eighth decades (70%). Common oral sites were mandibular alveolar ridge/gingiva (25%), buccal mucosa (18%), maxillary alveolar ridge/gingiva (17%), and tongue (17%). The histopathologic diagnosis ranged from verrucous hyperkeratosis (VH) with no/mild/moderate dysplasia (60%) to VH with severe dysplasia/squamous cell carcinoma (SCC) in situ (12%), and conventional SCC (12%), and 1 was explicitly identified as verrucous carcinoma. Twenty-three cases could be retrospectively described as proliferative verrucous leukoplakia based on multiple sites and protracted clinical course (16%), of which 19 progressed to severe dysplasia/SCC-in situ/SCC (83%). Conclusions The demographic profile echoes some variation described in the literature. The range of terminology not only mirrors the literature but highlights the challenges encountered by pathologists in diagnosing these lesions: not just in assigning lesions as VH with/without dysplasia, but also in distinguishing them from verrucous carcinoma/SCC. Our experience lends further support to the call for creation and adoption of standardized criteria and terminology to reflect the complex biological, clinical, histopathologic, and management implications of these entities.