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rev port estomatol med dent cir maxilofac . 2026;67(1):27-33 31

must be managed as conventional SCC. 7,37 The 5-year overall dysplasia, and hybrid SCC. Thus, histopathologic distinction is
survival rate ranges from 64% to 94%, and the stage at diagno- essential for appropriate management, as VC requires more
sis is the most relevant prognostic factor. 7,16,17 In oral VC cases, conservative treatment than conventional SCC. In addition,
surgical intervention appears to be related to improved overall close communication between the clinician and the patholo-
survival, whereas advanced age and higher staging are asso- gist is mandatory for a correct diagnosis. Ultimately, the treat-
ciated with worse overall survival and disease-specific surviv- ment of choice for VC is surgical excision. While the role of
al rates. 53 radiotherapy remains controversial, some authors suggest it
Furthermore, it is important to distinguish VC from other for extensive tumors where surgery is not feasible or for pa-
verrucous lesions, particularly proliferative verrucous leuko- tients with poor general health status.
38
plakia and verrucous hyperplasia (VH). Proliferative verru-
cous leukoplakia is an uncommon, progressive form of multi-
focal leukoplakia characterized by a high rate of malignant Conflict of interest
transformation to SCC or VC, as well as a significant recurrence
rate. Although lesions often begin as simple, flat hyperkerato- The authors have no conflicts of interest to declare.
sis, indistinguishable from conventional leukoplakia, prolifer-
ative verrucous leukoplakia presents persistent growth, evolv-
38
ing into exophytic, verrucous forms. Thus, current evidence Ethical disclosures
suggests that untreated leukoplakia can progressively evolve
into VH and/or VC. 11 Protection of human and animal subjects. The authors
11
Clinical distinction between VH and VC is challenging. declare that the procedures followed were in accordance with
VH is considered an antecedent or early form of VC, and the the regulations of the relevant clinical research ethics com-
transition is so consistent that dysplasia, once diagnosed, mittee and with those of the Code of Ethics of the World Med-
should be treated as VC. 4,38,54,55 Strict clinical monitoring of VH ical Association (Declaration of Helsinki).
11
is essential to detect any potential transition to VC. The dif-
ferential diagnosis is established microscopically, but an inci- Confidentiality of data. The authors declare that they have
sional biopsy must be performed with adequate margins to followed their work center protocols on access to patient data
ensure a correct diagnosis. In VH, the hyperplastic epithelium and for its publication.
and verrucous processes are superficial to the adjacent normal
epithelium. In contrast, in VC, although the verrucous process- Right to privacy and informed consent. The authors have
es are superficial, the epithelial ridges extend deeply relative obtained the written informed consent of the patients or sub-
to the adjacent normal epithelium. 38,56,57 Finally, VC must also jects mentioned in the article. The corresponding author is in
be differentiated histologically from papillary SCC, which ex- possession of this document.
hibits marked cellular atypia and frank invasion of the base-
ment membrane. 7
It is noteworthy that a thorough microscopic examination CRediT authorship contribution statement
is essential for the differential diagnosis and appropriate treat-
31
ment of VC and other verrucous lesions. Santoro et al. iden- Josivaldo Bezerra Soares: Conceptualization, Formal analysis,
tified common pitfalls during the evaluation of verrucous le- Investigation, Project administration, Supervision, Visualiza-
sions: histologically underdiagnosed cases, diagnosed as tion, Writing – original draft, Writing – review & editing. Beat-
keratosis or VH, with synchronous or metachronous aggressive riz Medeiros Batista: Investigation, Visualization, Writing –
growth patterns; clinically undertreated cases, with prolifera- original draft, Writing – review & editing. Sérgio Cantídio
tive verrucous leukoplakia and VC lacking a microscopic diag- Carneiro Morais: Visualization, Writing – original draft, Writ-
nosis of epithelial dysplasia; and surgically overtreated cases, ing – review & editing. Cícera Dalylla Lopes Ferreira: Visuali-
including VC managed as conventional SCC, with radical re- zation, Writing – original draft, Writing – review & editing.
section and unnecessary lymphadenectomy. Thus, an accurate Katia Caetana Pereira: Visualization, Writing – original draft,
diagnosis relies on a comprehensive assessment of all charac- Writing – review & editing. Paulo Rogério Ferreti Bonan: Con-
teristics rather than an isolated evaluation of individual find- ceptualization, Visualization, Supervision, Writing – review &
ings, and close collaboration between clinicians and patholo- editing.
gists is essential. 31
VC is a rare variant of oral SCC characterized by locally
invasive and typically non-metastatic behavior, carrying a orcid
more favorable prognosis than conventional SCC. The differ-
ential diagnosis between VC and other verrucous lesions re-
mains a challenge for pathologists, especially when biopsy Josivaldo Bezerra Soares 0000-0002-0283-5090
specimens are insufficient and inaccurate and obtained from Beatriz Medeiros Batista 0009-0000-6392-919X
unrepresentative areas. An adequate biopsy from the periph- Sérgio Cantídio Carneiro Morais 0000-0002-4945-9555
ery of the lesion, with sufficient depth and inclusion of adja- Cícera Dalylla Lopes Ferreira 0000-0001-8726-8277
cent normal tissue, is critical for differential diagnosis and for Katia Caetana Pereira 0000-0002-0781-9970
the analysis of potential areas of cytologic atypia, epithelial Paulo Rogério Ferreti Bonan 0000-0002-4449-4343