Ann Dermatol Vol. 23, Suppl. 1, 2011 CASE REPORT http://dx.doi.org/10.5021/ad.2011.23.S1.S68 Treatment of Verrucous Carcinoma of the Lower Lip Ⓡ with Topical Imiquimod (Aldara ) and Debulking Therapy Hyok Bu Kwon, M.D., Yun Seok Choi, M.D., Joon Ho Lee, M.D., Sang Yun Jin, M.D., Beom Joon Kim, M.D.1, Seung Ho Lee, M.D., Ai Young Lee, M.D. Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, 1Chung-Ang University of Medicine, Seoul, Korea Verrucous carcinoma is an unusual, non-metastasizing, distinct variant of squamous cell carcinoma composed of four subtypes according to the site of occurrence: oral type, anogenital type, plantar type, and other cutaneous sites. Oral type verrucous carcinoma usually shows slow progression with a low incidence of metastases. Treatment of verrcous carcinoma is challenging; multiple medical and surgical therapies are often attempted, with limited success. We reported on 2 cases of verrucous carcinoma of the lip treated with topical imiquimod and debulking therapy. (Ann Dermatol 23(S1) S68∼S71, 2011) -Keywords- Lasers, gas; Cryotherapy; Imiquimod; Carcinoma, verrucous INTRODUCTION Verrucous carcinoma is an unusual, distinct variant of squamous cell carcinoma, which was first reported by Ackerman in 19481. Verrucous carcinomas consist of oral tumors on the buccal mucosa, which have been referred Received March 24, 2010, Revised August 27, 2010, Accepted for publication September 18, 2010 Corresponding author: Ai-Young Lee, M.D., Ph.D., Department of Dermatology, Dongguk University Ilsan Hospital, 814 Siksa-dong, Ilsandong-gu, Goyang 410-773, Korea. Tel: 82-31-961-7250, Fax: 82-31-961-7258, E-mail: lay5604@naver.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. S68 Ann Dermatol to as oral florid papillomatosis2. These tumors may be clinically mistaken for giant warts, and both clinical and histological diagnosis must be established. Malignant transformation of verrucous carcinoma into squamous cell carcinoma has been reported in 30∼50% of cases3; however, no clear guidelines for effective and safe management of this disease are currently available. Here, we report on two cases of verrucous carcinoma of the lower lip, which were treated with a combination of topical imiquimod (AldaraⓇ) and debulking therapy. CASE REPORT Case 1 A 70-year-old male patient presented with an extensive verrucous, hyperkeratotic tumor on the central aspect of his lower lip (Fig. 1A). The tumor had been growing for 1 month. The patient was a smoker and a social alcohol drinker. However, his history of trauma to the lesion was unremarkable and he had no past medical history or family history of similar lesions or other skin diseases. Physical examination revealed an exophytic verrucous yellowish-to-whitish tumor measuring approximately 4 cm in diameter. The patient complained of mild tenderness on the lesion and the tumor was firm upon palpation. No lymphadenopathy was detected on the neck or sublingual area. Microscopic examination of a punch biopsy specimen revealed an endophytic epidermal proliferation with bulbous and blunted projections composed of large well- differentiated squamous epithelial cells extending into the reticular dermis (Fig. 2A). Cellular pleomorphism was minimal and mitotic activity was confined to the basal