Verrucous Carcinoma of the Toenail: A Case Report and Review of Literature

Abstract

Verrucous carcinoma (VC) is a rare, highly keratinized, well-differentiated, low-grade squamous cell carcinoma. A 58-year-old male presented with a 5-year history of a recurrent growing hyperkeratotic mass with intermittent bloody discharge, ulceration and dystrophic nail change on the right fifth toe. Since multiple dermatologic treatments were yielding no response, punch biopsy was performed for a more accurate diagnosis and the result was consistent with verruca vulgaris. As the lesion was responding poorly despite further dermatologic treatments for verruca vulgaris, radical surgical resection was performed. Microscopic examination of the excised lesion revealed epidermis with hyperkeratosis, hypergranulosis, papillomatosis, and reticular dermis invasion, consistent with VC. Since the diagnosis changed to VC, and the resection margin was involved by the carcinoma, the patient underwent an amputation procedure at the proximal phalangeal base. This case report highlights the importance of diagnosing VC. In cases of lesions such as verruca vulgaris or onychomycosis that are not responsive to general treatment, physicians should consider VC as a differential diagnosis, to prevent delaying a proper diagnosis and progression of disease.