Oral cancer in India carries a geography that maps almost perfectly onto tobacco habits. The gingivo-buccal sulcus, the floor of the mouth, the lateral tongue — these are the sites where years of tobacco contact leave their most damaging marks. When a middle-aged man walked in with a white, warty growth on his lower jaw mucosa, I recognised it before the biopsy came back.
Verrucous carcinoma — a low-grade variant of oral squamous cell carcinoma — has a look that is difficult to mistake once you have seen it. Exophytic, warty, white, slow-growing. It is the kind of lesion that gives patients false comfort precisely because it grows slowly and doesn't ulcerate early. But make no mistake: it is a malignancy. And it required prompt, careful surgical management.
What Makes Verrucous Carcinoma Different?
Within the spectrum of oral malignancies, verrucous carcinoma occupies a somewhat unique position. Unlike conventional squamous cell carcinoma, it rarely metastasises to regional lymph nodes — but it is locally aggressive, invading adjacent bone and soft tissue with persistent determination.
The typical patient in India is a middle-aged male who has been using tobacco — chewed tobacco, paan masala, or gutka — for years. The carcinogenic compounds in these products accumulate at the site of habitual contact, gradually inducing cellular changes that eventually, silently, tip into malignancy.
The gross pathology of this tumour is what gives it its name: verruca means wart. The growth has a cauliflower-like, exophytic surface, white or grey in colour, sitting on an otherwise normal-looking mucosal base. The intraoral photograph in this case shows the characteristic appearance clearly — a warty, white growth that demands excision.
The Surgical Approach: Wide Excision and Peripheral Ostectomy
Treatment for verrucous carcinoma is surgical. Wide local excision — removal of the tumour with an adequate margin of normal tissue on all sides — is the gold standard. In this patient, the tumour was located adjacent to the mandibular bone, which meant the surgery involved two distinct phases.
First, the soft tissue excision: the lesion was excised with wide margins, ensuring no tumour cells were left at the edges. Second, peripheral ostectomy: since the tumour was in contact with bone, the superficial layer of the mandibular cortex was carefully removed using a surgical bur, providing a clear bone margin. This step is critical — tumour cells that have seeded the periosteum or superficial bone will cause recurrence if not addressed.
After the tumour and its bone margin were removed, the resulting surgical defect was reconstructed using a collagen membrane. Collagen serves as a biological scaffold — it promotes wound healing, reduces the risk of infection, and allows the mucosa to regenerate over the defect in an organised manner. The excised specimen, visible in the case photographs, shows the classic cauliflower-like gross appearance that confirms the diagnosis visually before histopathology.
Why I Always Discuss Tobacco with My Surgical Patients
Every patient who presents with tobacco-related oral cancer leaves my clinic with a clear conversation about tobacco cessation. Surgery is the treatment. Stopping tobacco is the prevention of the next tumour. Verrucous carcinoma, despite its relatively favourable prognosis compared to other oral malignancies, recurs if the carcinogenic stimulus continues. I make this conversation non-negotiable.
For Patients and Referring Clinicians
For patients: any persistent white, red, or warty lesion in the mouth — particularly in tobacco users — should be evaluated promptly by an oral and maxillofacial surgeon or an oral medicine specialist. Do not allow a "not painful" lesion to remain uninvestigated for more than two to four weeks.
For referring colleagues: verrucous-appearing oral lesions in tobacco users are malignant until proven otherwise. Early referral allows surgical management before significant bone involvement, avoiding more complex resections and reconstructions.
This patient's tumour was excised with clear margins. The defect healed beautifully over the collagen scaffold. And he knows, now, what tobacco cost him.
— Dr. Hema | Oral & Maxillofacial Surgeon | Hyderabad
Let's talk about your case
Whether you're a patient researching options, a family member trying to understand a diagnosis, or a GP or dentist with a complex referral — reach out.
Let's talk about your case
Whether you're a patient researching options, a family member trying to understand a diagnosis, or a GP or dentist with a complex referral — reach out.
Let's talk about your case
Whether you're a patient researching options, a family member trying to understand a diagnosis, or a GP or dentist with a complex referral — reach out.