Verrucous Carcinoma of the foot: A non-healing ulcer

• Author Details:   
• Krishna Kumar Dhakchinamoorthi ^*
• Lekha Sakthivel
• Jisha Joe RJ
• Raju Nagappan

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Verrucous carcinoma is an uncommon, well-differentiated type of squamous cell carcinoma (SCC) with slow progression, minimal potential for invasion, and metastasis. While commonly found in the oral and genital mucosa, its manifestation on the foot is uncommon, typically occurring in weight-bearing areas, such as the ball of the great toe. Chronic inflammation, trauma, and HPV infection are all considered risk factors. We report the case of a 58-year-old male with a non-healing ulcer on his right foot that was first caused by trauma. Despite multiple interventions, including antibiotics and topical treatments, the lesion gradually progressed into a large, exophytic mass. Biopsy and histopathology confirmed a diagnosis of verrucous carcinoma with pseudoepitheliomatous hyperplasia. Radiographic imaging aided in assessing the extent of the lesion, and due to its severity and chronicity, a lower limb amputation was performed. Post-operative recovery was uneventful. This case highlights the diagnostic challenges posed by verrucous carcinoma, particularly when it mimics chronic ulcers or benign lesions. Histopathological analysis remains crucial for accurate diagnosis, as it distinguishes VC from conditions such as pyoderma vegetans or verruca vulgaris. Advanced imaging techniques, such as CT scans, are useful in assessing bone involvement when MRI results are inconclusive. Early recognition and surgical intervention are crucial to avoid extensive morbidity. This case report emphasizes the need to include verrucous carcinoma in the differential diagnosis of chronic foot ulcers, particularly those with a history of trauma or persistent inflammation, to avoid delayed diagnosis and limit the need for radical procedures.