A 62-year-old male tobacco chewer has a large warty white plaque over the right buccal mucosa. Biopsy shows markedly hyperkeratotic squamous epithelium with acanthosis and broad bulbous rete ridges pushing into the stroma, with minimal cellular atypia. Which statement about management is most accurate?
- A Radical neck dissection should be performed routinely
- B Definitive radiotherapy gives the best local control
- C Wide surgical excision with clear margins is the treatment of choice ✓
- D Primary chemotherapy followed by response assessment
Correct answer: C. Wide surgical excision with clear margins is the treatment of choice
Explanation
Verrucous carcinoma is a highly differentiated variant that pushes into the stroma as broad bulbous ridges and almost never metastasizes to cervical nodes. Wide local excision with clear margins is curative. Radiation is deliberately avoided because it may provoke anaplastic transformation with aggressive behaviour, which is exactly why option B fails. Radical neck dissection and chemotherapy are unwarranted given the negligible nodal risk.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.