Etiology • A well-differentiated, exophytic and endophytic squamous cell
carcinoma often associated with tobacco use, especially smokeless tobacco
• A primary or ancillary role for HPV is suspected. • May be preceded by keratotic patch (see “Verrucous
Hyperplasia” on page 158)
Clinical Presentation • One-half of cases involve the buccal mucosa. • Attached gingiva is involved in one-third of cases. • Early, superficial lesions often are interpreted as verrucous
hyperplasia; lesions become exophytic, irregular, and indurated. • Advancing lesions push into adjacent tissues. • Late lesions invade the periosteum and destroy bone. • Metastases are rare.
carcinoma often associated with tobacco use, especially smokeless tobacco
• A primary or ancillary role for HPV is suspected. • May be preceded by keratotic patch (see “Verrucous
Hyperplasia” on page 158)
Clinical Presentation • One-half of cases involve the buccal mucosa. • Attached gingiva is involved in one-third of cases. • Early, superficial lesions often are interpreted as verrucous
hyperplasia; lesions become exophytic, irregular, and indurated. • Advancing lesions push into adjacent tissues. • Late lesions invade the periosteum and destroy bone. • Metastases are rare.
Microscopic Findings • Well-differentiated, blunt masses of epithelium extending into
submucosa • Intense lymphocytic infiltrate adjacent to invasive front
Diagnosis • Microscopic findings • Full-thickness specimen is necessary to establish diagnosis
Differential Diagnosis • Verrucous hyperplasia • Papillary squamous cell carcinoma • Proliferative verrucous leukoplakia
Treatment • Wide excision • Radiation therapy may be effective. • Dedifferentiation may occur spontaneously or after radiation
therapy.
Prognosis • Excellent • Local recurrence is a distinct possibility.