Clin Oral Invest (2006) 10: 205–209 DOI 10.1007/s00784-006-0050-7 ORIGINAL ARTICLE Denise Tostes Oliveira . Renato Vieira de Moraes . Jorge Francisco Fiamengui Filho . João Fanton Neto . Gilles Landman . Luiz Paulo Kowalski Oral verrucous carcinoma: a retrospective study in São Paulo Region, Brazil Received: 26 October 2005 / Accepted: 20 April 2006 / Published online: 1 June 2006 # Springer-Verlag 2006 Abstract Oral verrucous carcinoma (OVC) is a rare variant of squamous cell carcinoma with a characteristic morphology and specific behavior. To date, few studies are available focusing the prevalence and clinicopathologic features of the oral verrucous carcinoma in Brazilian population. A total of 3,500 primary oral well-differen- tiated squamous cell carcinoma surgically excised in the A. C. Camargo Cancer Hospital and Amaral Carvalho Cancer Hospital, Brazil, from 1980 to 2000 were retrospectively reviewed. Twenty cases of verrucous carcinomas were identified, most of them occurring in older male with age above the sixth decade, the sites frequently affected being the lower lip and the hard palate. Microscopically, the tumor showed a heavily keratinized lesion with compres- sive invasion pattern, little atypia, and free surgical margins. The local recurrence was verified in 38.5% of the patients with oral verrucous carcinoma; however, regional recurrence and distant metastasis were not verified. The results suggest that, although it is less frequent and with excellent prognosis, the verrucous carcinoma presents a potential for local recurrence that should be considered during the surgical planning of this neoplasm in the oral cavity. Keywords Verrucous carcinoma . Oral squamous cell carcinoma . Oral cancer . Verrucous lesion . Prognosis Introduction Oral verrucous carcinoma (OVC) is a rare variant of squamous cell carcinoma with a characteristic morphol- ogy and specific behavior. The tumor occurs frequently in the oral cavity and larynx [4, 13, 17] but its etiopatho- genesis remains unclear [2, 12, 15, 17]. Clinically, one of the intriguing aspects of this malignant tumor is its slow growth and aspect vegetant in cauliflower that can become locally aggressive if not treated [1, 5, 13, 17, 20], without any regional or distant metastasis [10, 12, 14, 17, 20]. Microscopically, this tumor first described by Ackerman [1] in 1948 is characterized by a predominant exophytic overgrowth of well-differentiated keratinizing epithelium having minimal atypia associated with intense chronic inflammatory infiltrate. In addition, locally destructive pushing margins at interface with underlying connective tissue can be found [7, 10, 12, 13, 17, 21]. The establishment of clinical or histopathological diag- nosis of verrucous carcinoma in the oral cavity may be difficult to interpret. The correct diagnosis is heavily dependent on close collaboration between clinician and pathologist, and the provision to the latter of a sufficiently large biopsy specimen [2, 7, 23]. To date, few studies are available focusing the preva- lence and clinicopathologic features of the OVC in Brazilian population and the samples are generally small and not representative [3, 9, 22]. The aim of this study was to evaluate, retrospectively in the period from 1980 to 2000, the clinicopathological features, outcome, and treatment of the OVCs in two centers for diagnosis and treatment of oral cancer in Brazil. D. T. Oliveira (*) . R. V. de Moraes . J. F. F. Filho Department of Stomatology, Area of Pathology, Bauru School of Dentistry, University of São Paulo, Al. Dr. Octavio Pinheiro Brizolla, 9-75, Bauru, São Paulo, 17012-901, Brazil e-mail: d.tostes@fob.usp.br Tel.: +55-21-142358251 Fax: +55-21-142234679 J. F. Neto Amaral Carvalho Cancer Hospital, Jaú, São Paulo, Brazil G. Landman Department of Pathology, A. C. Camargo Cancer Hospital, São Paulo, Brazil L. P. Kowalski Department of Head and Neck Surgery and Otorhinolaryngology, A. C. Camargo Center Hospital, São Paulo, Brazil