Verrucous Carcinoma — ORE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

HardOral PathologyVerrucous CarcinomaORE Part 1

A patient presents with a painless, elevated, verrucous (warty) white lesion on the buccal mucosa. It has been slowly growing over 5 years. Biopsy shows well-differentiated squamous epithelium with broad, pushing margins and no invasion through the basement membrane. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Verrucous carcinoma

Explanation lettering: D = shown as A · A = shown as B · E = shown as D · B = shown as E

Verrucous carcinoma (VC) is a well-differentiated, low-grade variant of squamous cell carcinoma. The defining histopathological features—intact basement membrane, broad rete pegs with pushing (non-invasive) margins, minimal cytological atypia, and dense keratinisation—precisely match the biopsy description. These features distinguish VC from conventional SCC, which shows frank invasion through the basement membrane and significant cytological atypia. The slow growth over years and painless white appearance on buccal mucosa are clinically typical. VC has excellent prognosis but requires surgical excision; misdiagnosis as benign hyperplasia or candidiasis (as in literature cases) delays appropriate management. Options B–E are eliminated: SCC requires basement membrane invasion (not present here); papilloma and verruca are benign with no malignant margin pattern; oral hairy leukoplakia is a benign keratotic lesion in immunocompromised patients.

Reference: Oral verrucous carcinoma complicating repetitive injury by dental prosthesis. NCBI PMC Articles, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4484201/; supported by Oral verrucous carcinoma: report of two cases and review of literature (PubMed 7905820) and Diagnostic Biomarkers in Oral Verrucous Carcinoma: A Systematic Review (PubMed 27924463).