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Case Reports
. 2025 Mar 16;17(3):e80645.
doi: 10.7759/cureus.80645. eCollection 2025 Mar.

Tackling Oral Giants: A Case of Verrucous Carcinoma Involving the Buccal Mucosa and Maxilla

Kshitij Bang  1 , Ramakrishna Shenoi  1 , Vrinda Kolte  1 , Karishma D Jadhav  1 , Hrushikesh K Malikar  1
Affiliations
Case Reports

Tackling Oral Giants: A Case of Verrucous Carcinoma Involving the Buccal Mucosa and Maxilla

Kshitij Bang et al. Cureus. .

Abstract

Verrucous carcinoma (VC) is an uncommon, well-differentiated variant of squamous cell carcinoma (SCC) with a locally aggressive yet non-metastatic nature. It primarily affects the oral cavity, particularly the buccal mucosa, lips, and hard palate. Clinically, it presents as an exophytic, warty, or cauliflower-like lesion that can be misdiagnosed due to its resemblance to non-neoplastic ulcerative conditions. Histopathologically, VC exhibits pronounced keratinization, hyperplastic epithelium, and a test-tube-like growth pattern without significant nuclear atypia or metastasis. This case report describes a 41-year-old male presenting with a persistent ulcero-proliferative lesion diagnosed as VC. Surgical management included wide local excision, supra-omohyoid neck dissection, and partial maxillectomy with marginal mandibulectomy, utilizing a lower lip split apron flap for optimal access and minimal scarring. The defect was reconstructed with an anterolateral thigh (ALT) flap. The case highlights the necessity for precise diagnosis, an interdisciplinary approach, and the importance of surgical strategies to achieve optimal treatment outcomes in VC patients.

Keywords: anterolateral thigh (alt) flap; mandibulectomy; maxillectomy; ulcero-proliferative lesion; verrucous carcinoma; wide local excision (wle).

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Intraoral presentation of ulcero-proliferative growth over the right maxilla and buccal mucosa
Figure 2
Figure 2. Palatal extension of the ulcero-proliferative growth
Figure 3
Figure 3. A biopsy image of the lesion. The image shown is in 10× magnification and stained with hematoxylin & eosin (H&E), demonstrating para-keratin plugging
Figure 4
Figure 4. Contrast-enhanced computed tomography image of the lesion
Figure 5
Figure 5. Surgical marking of the lower lip split approach
Figure 6
Figure 6. Ipsilateral supraomohyoid neck dissection and facial vessels (see arrow) preservation for microvascular anastomosis for reconstruction
Figure 7
Figure 7. Intraoperative image of the site of the lesion after bite resection and right maxillectomy. The arrow demonstrates the defect
Figure 8
Figure 8. Image of the resected specimen of the lesion showing adequate safety margins
Figure 9
Figure 9. Image taken four months post-surgery
Figure 10
Figure 10. Four months postoperative image: intraoral view showing a healthy flap
See this image and copyright information in PMC

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