Clinical cases

Introduction: Verrucous carcinoma is a welldifferentiated epidermoid carcinoma which affects mainly men aged over 50 years. It is located mainly on the lower limbs and mucosa. The subungual involvement is exceptional.

Clinical case: A 72 year-old male patient, with no particular medical history, with good general condition, was consulted for a verrucous lesion of the third toe of the left foot that that appeared 18 months ago and became troublesome when wearing footwear. Clinical examination revealed a painless hyperkeratotic verrucous lesion, located on ventral side of the third toe with subungual involvement.
The patient presented no other mucocutaneous lesions or lymphadenopathy. The histopathological examination
showed a well-differentiated epithelial proliferation with rare cellular atypia, the epithelial strips being in continuity with
epidermis on the surface and invading dermis in depth. The radiography of the third toe of the left foot revealed a bone lysis corresponding of skin involvement. Surgical excision with amputation of the last phalanx of the third toe of the left foot was performed.

Discussion: Verrucous cancer has only local malignancy with slow progression, with invasion of underlying soft tissue and eventually of the bone (10% of cases). Visceral metastases are exceptional. Differential diagnosis is made with Bowen's disease, keratoacanthoma, melanoma, warts, verrucous tuberculosis, deep mycoses and atypical mycobacteriosis. The treatment of choice is complete and wide surgical excision, sometimes requiring amputation.