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28 rev port estomatol med dent cir maxilofac . 2026;67(1):27-33

oral lesions present as asymptomatic, well-demarcated exo-
phytic growths with superficial papillary or verruciform pro-
jections, often resembling cauliflower. The lesions are usually
white but can appear pink or erythematous. 9
VC accounts for approximately 2−12% of all oral carcino-
10
mas. Although the etiology is not well understood, risk fac-
tors commonly associated with VC development include
smoking, tobacco chewing, alcohol consumption, and poor
oral hygiene. Other etiological factors include human papillo-
mavirus (HPV), areca nut chewing, immunosuppression, oral
leukoplakia, and oral submucous fibrosis. 11,12 The treatment
13
of choice for oral VC is surgical excision with wide margins.
Overall, the prognosis is favorable, with a 5-year survival rate
of approximately 80%; however, the recurrence rate varies
from 30% to 50%. 14,15
This paper presents two cases of oral VC in elderly men
occurring in unusual locations — the palate and the lower lip, Figure 2. Photomicrograph showing exophytic tumor
followed by a literature review emphasizing clinical features, with church spire sign and broad, bulbous epithelial
histological findings, and treatment modalities. ridges that appeared to push against the underlying
connective tissue (H&E, 40x).

Case reports

Case 1
A 77-year-old male patient was referred to the (placeholder for
the institution’s name) for evaluation of a white verrucous le-
sion on the lower lip with a duration of approximately 1 year.
The medical history revealed no systemic diseases or drug
allergies. In addition, the patient reported a 63-year history of
smoking. On physical examination, no regional lymphadenop-
athy was observed. A whitish exophytic lesion was present on
the vermilion border and mucosa of the lower lip. The plaque
was thick and well-circumscribed, with a papillary surface and
a sessile base, measuring approximately 3 cm in diameter (Fig-
ure 1). Based on these findings, a clinical hypothesis of VC was
established. An incisional biopsy was performed under local
anesthesia, and the specimen was submitted for histopatho-
logical examination.
Figure 3. Photomicrograph showing mild cytologic
atypia in the basal layer and absence of frank invasion
(H&E, 100x).

Microscopic examination demonstrated a well-differen-
tiated stratified squamous epithelium with marked superfi-
cial keratinization and verrucous exophytic projections, con-
sistent with the “church spire” sign. Additionally, the
hyperplastic epithelium exhibited endophytic growth with
broad, bulbous epithelial ridges pushing into the underlying
connective tissue (Figure 2). At higher magnification, mild
cytologic atypia was observed in the basal layer, with no ev-
idence of overt invasion (Figure 3). The underlying connective
tissue showed a chronic inflammatory infiltrate composed
predominantly of lymphocytes, as well as rich vascularity
and no lymphovascular or perineural invasion. Therefore, a
histopathologic diagnosis of VC was confirmed. The patient
Figure 1. Extraoral examination showing a white
verrucous lesion on the lower lip. was referred to a head and neck surgeon and is currently
undergoing treatment.