Diagnosis and treatment of verrucous squamous cell carcinoma of the larynx: a critical review.

Verrucous squamous cell carcinoma of the larynx is a clinical and pathological entity which was recognized only in recent years. It is a highly differentiated variant of squamous carcinoma whose incidence is difficult to assess (3.82% of all laryngeal malignant lesions in our series of 3,012 patients seen from 1966 through 1983). The laryngologist and the pathologist must cooperate closely to formulate a correct diagnosis, because the microscopic findings may not show cytological criteria for malignancy, while the clinical appearance of the exophytic, broadly implanted, and fungating lesion is suggestive of malignancy. A large enough specimen is required to carry out adequate investigations in order to differentiate the lesion from keratosis, verruca vulgaris, or squamous cell carcinoma with a verrucous appearance. The most effective form of treatment is surgery, because radiotherapy has shown a high rate of recurrence or persistence of tumor and because there is the risk of occasional anaplastic or sarcomatoid transformation as seen in this and other sites. Neck dissection is not indicated because the tumor has not shown an ability to spread to regional lymph nodes or to distant organs.