Case Report of Verrucous Carcinoma Arising in Sacral Pressure Sore

ABSTRACT

PURPOSE: Verrucous carcinoma is a rare, low-grade and well-differentiated squamous cell carcinoma, representing as a warty tumor. Estimation of the incidence for cutaneous lesions is not available because they are rare. We describe a case of verrucous carcinoma, a rare type, complication of a chronic pressure ulcer of duration more than 15 years. METHODS: A 17-year-old boy presented with a large lesion involving the sacral area, which had been neglected for about 15 years. He had a history of surgical extirpation 2 years ago, but not cured. Examination revealed a cauliflower-like mass arising from an irregularly oval-shaped tumor which was 6.0x4.5cm in size with signs of infection and ulcer. The lesion involved the sacrococcygeal area, spreading to both medial gluteal regions. The perianal skin did not appear to be directly affected. RESULTS: A preoperative punch biopsy revealed a extremely well differentiated verrucous carcinoma. There were positive results in immunohistochemistry in the items of p53, p63, Ki-67. An 'en-bloc' excision of the tumor with the clinically normal surrounding tissue was carried out. Reconstruction was achieved by local regional flap. Histopathological findings of the excised area fully confirmed the preoperative biopsy report. It remained free of recurrence for a period of about 8 months. CONCLUSION: We believe that in patients with buttock involvement, regardless of the extent of such tumors, surgical therapy should be considered as the first-choice of treatment as reconstruction can be performed without excessive impairment for the patient.