Plantar Verrucous Carcinoma

Consider Carcinoma Cuniculatum in Recurrent Foot Ulcer: A Case Report and Literature Review

“…Besides viral warts, some of the other conditions that have been reported to be mimicked by this tumor and thus should be included in the differential diagnosis are keratoacanthoma, giant seborrheic keratosis, giant condyloma acuminatum, epidermic cyst, pyogenic granuloma, and amelanocytic melanoma among others. [5][6][7]10,11 In the later stages, if it evolves into a chronic lesion with aggressive invasion of underlying tissue the differential diagnosis should also include Marjolin's ulcer. Additionally, some authors have emphasized the importance of differentiating between carcinoma cuniculatum and verrucous skin lesions on the foot in diabetic neuropathy, since it is not uncommon for the demography of both diseases to overlap and differential diagnosis can be difficult if tissue biopsy is not taken appropriately.…”

“…1 2 5 6 7 Following the incomplete resection, the tumor will recur, and if left untreated it will eventually ulcerate while slowly growing and invading underlying soft and bone tissue, sometime mimicking an osteomyelitis. 9 10 Despite the potential invasion of underlying deep tissue, distant metastasis is extremely rare, only five cases have been reported. 11…”

“…5 6 It is also not uncommon for the tumor to have been biopsied previous to definitive diagnosis and reported as benign findings such as a wart or reactive epidermal hyperplasia. 1 2 5 6 7 10 11 12 For these reasons, it is important to think of carcinoma cuniculatum when presented with a repeating ulcer on the foot, arising from a seemingly benign lesion that keeps recurring despite attempts of surgical removal.…”

“…Following the incomplete resection, the tumor will recur, and if left untreated it will eventually ulcerate while slowly growing and invading underlying soft and bone tissue, sometime mimicking an osteomyelitis [9,10]. The recommended treatment of epithelioma cuniculatum is surgical excision, with complete tumor extirpation and 5 mm margins.…”