Carcinoma Cuniculatum with Bone Invasion Mimicking a Viral Wart
Carcinoma cuniculatum is a rare variant of low-grade and well-differentiated squamous cell carcinoma. It is a locally invasive tumor, although it has low metastatic potential. It was originally described in the plantar region but may exceptionally appear in other locations. It predominates in middle-aged men and presents clinically as an exophytic, solitary, painful tumor, with insidious growth. Histologically, this tumor simulates a variety of benign dermatoses and may require several biopsies for the correct diagnosis. It is often misdiagnosed as a viral wart, due to the clinical similarity and the indolent course. The treatment of choice is surgical excision due to the high risk of recurrence and locally aggressive behavior. Amputation can be performed in cases of deep tissue invasion. We present a case of carcinoma cuniculatum in which the late diagnosis favored the invasion of the underlying bone, resulting in amputation of the affected finger.
Arisi M, Zane C, Edu I, Battocchio S, Petrilli G, Calzavara-Pinton PG. Carcinoma Cuniculatum of the Foot Invading the Bone Mimicking a Pseudo-Epitheliomatous Reaction to an Acute Osteomyelitis. Dermatol Ther. 2016;6:95-9.
Feldmann R, Wruhs M, Peinhaupt T, Stella A, Breier F, Steiner A. Carcinoma Cuniculatum of the Right Thenar Region with Bone Involvement and Lymph Node Metastases. Case Rep Dermatol. 2017;9:225-230.
Lee HM, Kim YS, Kim JP, Lee JI, Uhm KS. An Unusual Presentation of Verrucous Carcinoma of the Foot with Bone Invasion. J Am Podiatr Med Assoc. 2016;106:427-429.
Vlahovic TC, Klimaz TL, Piemontese MK, Zinszer KM. Plantar verrucous carcinoma: an unusual case of bone invasion and osteomyelitis. Adv Skin Wound Care. 2009;22:554-6.
Ray R, Bhagat A, Vasudevan B, Sridhar J, Madan R, Ray M. A Rare Case of Plantar Epithelioma Cuniculatum Arising from a Wart. Indian J Dermatol. 2015;60:485-7.
Fonseca FP, Pontes HA, Pontes FS, et al. Oral carcinoma cuniculatum: two cases illustrative of a diagnostic challenge. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:457-63.
Barreto JE, Velazquez EF, Ayala E, Torres J, Cubilla AL. Carcinoma cuniculatum: a distinctive variant of penile squamous cell carcinoma: report of 7 cases. Am J Surg Pathol. 2007;31:71-5.
Bouwes Bavinck JN, Feltkamp M, Struijk L, ter Schegget J. Human papillomavirus infection and skin cancer risk in organ transplant recipients. J Investig Dermatol Symp Proc. 2001;6:207-11.
Herold M, Nielson C, Longo MI. Isotretinoin and candida immunotherapy for recalcitrant warts in solid organ transplant recipients. Dermatol Ther. 2019;32:e12803.
Patraşcu V, Geoloaica LG, Ciurea RN. Acral Verrucous Carcinoma. Curr Health Sci J. 2019;45:235-40.
Gertler R, Werber KD. Management of verrucous carcinoma of the hand: a case report. Int J Dermatol. 2009;48:1233-5.
Arefi M, Philipone E, Caprioli R, Haight J, Richardson H, Sheng Chen. A case of verrucous carcinoma (epithelioma cuniculatum) of the heel mimicking infected epidermal cyst and gout. Foot Ankle Spec. 2008;1:297-9.
Halpern J, Harris S, Suarez V, Jeyaratnam R, Smith AG. Epithelioma cuniculatum: A case report. Foot Ankle Surg. 2009;15:114-6.
Suen K, Wijeratne S, Patrikios J. An unusual case of bilateral verrucous carcinoma of the foot (epithelioma cuniculatum). J Surg Case Rep. 2012;2012:rjs020.
di Meo N, Stinco G, Nan K, Degrassi F, Cova MA, Trevisan G. Carcinoma Cuniculatum: Usefulness of Radiological Assessment. Indian J Dermatol. 2016;61:123.
Kuan YZ, Hsu HC, Kuo TT, Huang YH, Ho HC. Multiple verrucous carcinomas treated with acitretin. J Am Acad Dermatol. 2007;56:S29-32.
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