What are the treatment options for verrucous hyperplasia?

Treatment Options for Verrucous Hyperplasia

Wide surgical excision is the recommended first-line treatment for verrucous hyperplasia due to its effectiveness in preventing recurrence and potential malignant transformation. 1

Clinical Characteristics and Diagnosis

Verrucous hyperplasia (VH) is a rare exophytic mucosal lesion that can occur in various sites, most commonly in the oral cavity. It presents as:

• Warty whitish-pink growth
• Exophytic lesion with verruciform appearance
• Can be classified into two types:
  • Plaque-type: flatter appearance
  • Mass-type: more exophytic and nodular 2

Diagnosis requires a biopsy with adequate depth to distinguish VH from verrucous carcinoma (VC), as the key differentiating factor is the lack of invasive growth in VH cases 3. Specialized pathological evaluation is crucial for accurate diagnosis.

Treatment Algorithm

1. First-line treatment: Wide surgical excision

   • Complete removal of the lesion with adequate margins 1, 3
   • Provides definitive treatment and tissue for histopathological examination
   • Allows distinction from verrucous carcinoma

2. Alternative treatments for specific cases:

   • Photodynamic therapy - particularly effective for oral verrucous hyperplasia 2
   • Topical therapy options:
     • Imiquimod 5% cream 1
     • 5-Fluorouracil cream 1

3. For non-surgical candidates:

   • Radiotherapy may be considered in cases where surgery is contraindicated 4
   • However, this should be approached with caution as radiation may induce malignant transformation in some cases

Treatment Considerations Based on Location

Oral Verrucous Hyperplasia

• Wide surgical excision is the treatment of choice
• Mass-type VH has a higher 5-year malignant transformation rate (17%) compared to plaque-type VH (3%) and should receive immediate treatment 2

Genital Verrucous Hyperplasia

• Similar to treatment of anal dysplasia in high-risk patients
• Options include topical therapy (fluorouracil, imiquimod), excision, or ablation 1

Extremity Verrucous Hyperplasia

• For verrucous hyperplasia at amputation sites, compression therapy is preferred over surgery due to high recurrence rates with surgical intervention 5

Monitoring and Follow-up

• Regular follow-up is essential due to the risk of recurrence and malignant transformation
• The mean time for malignant transformation is approximately 22 months 2
• Long-term monitoring for at least 5 years is recommended

Important Considerations

• The overall 5-year malignant transformation rate for oral verrucous hyperplasia is approximately 10% 2
• Mass-type lesions have a significantly higher risk of malignant transformation than plaque-type lesions
• Risk factors for development include tobacco use and areca quid chewing (for oral lesions) 2
• Untreated lesions have a higher risk of malignant transformation compared to those that undergo complete excision

Clinical Pitfalls to Avoid

1. Inadequate biopsy depth - May lead to misdiagnosis between VH and verrucous carcinoma
2. Misdiagnosis as common warts - VH should not be confused with viral warts or verrucous carcinoma 5
3. Repeated surgical removals without definitive treatment - Can lead to recurrence and potential malignant transformation
4. Failure to monitor for recurrence - Regular follow-up is essential even after successful treatment

By following this treatment approach, patients with verrucous hyperplasia can achieve good outcomes with minimal risk of recurrence or malignant transformation.