[Verrucous carcinoma of the face: a report of 2 cases].

Actas Dermosifiliogr. 2009;100:151-62 160 asymptomatic tumor of 2 cm in diameter in the region of the left cheek that had grown progressively over the last 6 months (Figure 1). Two biopsies were taken with inconclusive results, and the tumor was finally removed. In the histological studies of the surgically removed tissue, findings characteristic of verrucous carcinoma were reported (Figure 2). Polymerase chain reaction (PCR) assay for the identification of the human papilloma virus (HPV) type 6, 11, 18, 31, and 33 was negative. There was no recurrence of the tumor 2 years after surgical removal. Case 2 was a 74-year-old man who attended in 2001 for a verrucous lesion 4 cm across at the widest point in the right temporal region that had been present for more than 2 years (Figure 3). Two biopsies were taken but the histological findings were inconsistent with the clinical appearance of the lesion. In view of the delicate condition of the patient and the inconclusive microscopic results, the tumor was removed by electrosurgery followed by curettage and electrocoagulation of the base of the lesion. Pathologic study of the tissue revealed histological changes indicative of verrucous carcinoma (Figure 4). PCR testing for HPV 6, 11, 16, 18, 31, and 33 was negative. The patient was monitored regularly over the following 3 years with no signs of local recurrence. In 1948, Ackerman coined the term “verrucous carcinoma” and established the clinical and histological criteria for diagnosis on the basis of 31 cases affecting the oral cavity. Previously, in 1896, Buschke and Löwenstein observed 2 patients with similar lesions in the genital region; with Aird et al describing plantar cuniculatum epithelioma in 1954.1-2 Verrucous carcinoma generally presents in the palmoplantar region, or on the oral, anal, and genital mucosa, and facial involvement is in fact exceptionally rare.1-7 Histological l y, verrucous carc inomas display microscopic similarities independent of location, showing a characteristic association of exophytic and endophytic components within the same lesion. The former consist of acanthosis and papillomatosis that generally display massive hyperkeratosis and frequent parakeratosis. The endophytic component is made up of a well-differentiated squamous epithelium, forming ”bulbous” projections or processes, lumps that increase in size ”pushing” the dermis. These extend to the reticular dermis and even the subcutaneous tissue, with no pattern of invasive growth. Other characteristics To the Editor: