CASE

PRESENTATION
NAME : MRS . VIJAYA
AGE : 60 YEARS
ADDRESS: Thalaivipuram

Chief complaint : C/O growth in the lower lip

for past 2 years

 HISTORY OF PRESENT ILLNESS

• H/O small growth which develops before 2 yrs , initially it was

small.

• Gradual increase in size

• Dull aching pain radiating to forehead, eyes and lower chin

• H/O difficulty in eating

Past medical / drug Past dental history: Family history: no
history: self fall of all teeth systemic illness
No relevant history
 PERSONAL HISTORY

● Tobacco & betel nut chewing for past 45 years

● Habit of placing quid in the right buccal vestibule

 GENERAL EXAMINATION
● Moderately built and nourished
● Patient is calm, conscious, well oriented to time and place
● No signs of Anemia, Jaundice, Clubbing, Cyanosis, Pedal edema,
Lymphadenopathy

VITALS:
● Pulse – 68 bpm
● BP – 110/80 mm/Hg
● RR – 18 breath /min
● Temp – Afebrile
 EXTRA ORAL EXAMINATION

FACIAL SYMMETRY TMJ LYMPH NODE

Asymmetry due Mouth opening R submandibular lymph node
to swelling in restricted is palpable of size 0.5 cm.
lips oval, firm, tender & fixed
 EXTRA ORAL LESION DESCRIPTION
LIPS: INSPECTION
● An exophytic growth in lower lip of right side
● Size – 3 x 4 cm
● Irregular shape
● Extension – right commissure of lip crossing midline
● Lesion over the growth is lobulated with crust formation
● Yellowish black discoloration of growth
● No evident bleeding or pus discharge
● Pseudomembranous slough is not noted
PALPATION:
● Soft to firm in consistency
● No rise in temperature
● Sessile base
● Non indurated
● No ulceration, pus or bleeding from growth
 INTRA ORAL EXAMINATION
BUCCAL MUCOSA : INSPECTION
● An ulcero proliferative lesion present in right buccal mucosa
● Size – 4 x 3 cm
● Extension – right commissure of lips
● Margins - irregular
● Mucosa over the lesion appears erythematous
● Yellowish white slough
● No evident bleeding or pus discharge
PALPATION : BUCCAL MUCOSA

● Firm in consistency

● Mild tenderness

● Everted margins

● Indurated base
LABIAL MUCOSA - INSPECTION
● Hyperkeratotic white plaque in lower labial mucosa
● size – 7 x 5 cm
● Extension – right buccal mucosa involving lower right
labial mucosa and extending to vestibular region
● Cracked mud appearance noted
● Yellowish white supercoating
● No evident ulceration, pus discharge or bleeding
PALPATION : LABIAL MUCOSA
● Soft in consistency

● Non tender

● Non scrappable

● No rise in temperature
 PROVISIONAL DIAGNOSIS

MALIGNANT NEOPLASM OF RIGHT

BUCCAL MUCOSA
 DIFFERENTIAL DIAGNOSIS

● Verrucous leukoplakia of right buccal mucosa

● OSCC of right buccal mucosa
● Verrucous carcinoma of right buccal mucosa
 Lesion Age Site M:F Clinical features

Buccal mucosa> • Gray or grayish-white

Verrucous 30–50 M>F
Labial mucosa> • Slightly lobular pattern and
leukoplakia years
Alveolar mucosa with indistinct borders blending
 Lesion Age Site M:F Clinical features

• Thickening, induration and

88.3% Lower lip>
ulceration or irregularity
OSCC 55 - 75 3.3% Upper lip > M>F
• Crater
years 8.3%labial
• Exophytic, proliferative growth
commissures
• Large fungating masses

Buccal mucosa > • Exophytic, appears

Verrucous
60–70 Gingiva>Alveolar • Papillary pebbly surface
carcinoma M>F
years ridge>Palate> Floor • Covered, white leukoplakic film
of mouth • Rugae-like folds with deep clefts
REVIEW OF LITERATURE
 INTRODUCTION
● Verrucous carcinoma (VC) is a rare, low-grade, well differentiated SCC

of the skin or mucosa presenting with a verrucoid or cauliflower-like

presence
● It is a tumor that tends to erode more than infiltrate with predominantly

horizontal growth and does not present with distant metastasis

OTHER NAMES

● Ackerman tumor and carcinoma cuniculatum

 MALIGNANT POTENTIAL
In the oral cavity

● verrucous carcinoma constitutes 2% to 4.5% of all forms of SCC.

 ETIOLOGY
● Human papilloma virus

● Chemicals from cigarettes (smoking)

● Physical source such as constant trauma and irritation

● Common factors like tobacco, alcohol consumption

● Irritation to the buccal mucosa by tooth.

 CLINICAL FEATURES
● Male > female
● Common site: larynx, external auditory meatus, buccal mucosa, gingiva, alveolar ridge
● Appearance : papillary lesion with pebbly appearance
● Margins : well defined slightly elevated normal mucosa
● Color; white but erythematous
● Lymph node: inflammatory
● Prognosis: good - absence or late appearance of metastases
 RADIOLOGIC FEATURE

Erosion of alveolar bone with moth eaten appearance

 MANAGEMENT
Excision must be sufficiently radical to remove the entire lesion
THANK YOU