VERRUCOUS CARCINOMA OF THE LARYNX

Verrucous carcinoma is a well-differentiated squamous cell carcinoma w ith minimal cytologic atypia. Characteristically, the surface shows pa pillary fronds with prominent hyperkeratosis. Its benign appearance ma kes diagnosis difficult and often delays treatment. This is a review o f 52 histologically confirmed cases of verucous carcinoma of the laryn x treated at the Mayo Clinic between 1960 and 1987. The follow-up rang ed from 2 to 304 months. The most common primary treatment modality wa s surgery. Two patients died of laryngeal cancer. In both cases, the r ecurrence was a high-grade carcinoma histologically distinct from the original verrucous carcinoma. The T stage, clinical stage, and type of surgical excision failed to predict survival. The presence of extensi ve leukoplakia surrounding the exophytic tumor approached statistical significance (p = .08) in predicting recurrence. Four patients were tr eated with radiotherapy - in each, to control residual disease. One of these patients developed a local recurrence. None of the irradiated t umors in this series showed anaplastic dedifferentiation, and none of the irradiated patients died of uncontrolled local or regional disease . We conclude that verrucous carcinoma of the larynx should be treated by conservative surgical resection when possible. Radiotherapy can be effectively used for disease that cannot be resected with preservatio n of laryngeal function. Total laryngectomy should be reserved for rec urrent disease or the rare case of anaplastic transformation.