Epithelioma cuniculatum: A case report

Challenging Recurrence and Management of Squamous Cell Carcinoma in the Calcaneal Region: A Case Report

Squamous cell carcinoma (SCC) is the second most common type of skin cancer. As ultraviolet exposure represents an important risk factor, SCC commonly occurs on the face, lips, scalp, hands, and heels. The foot is an unusual location to manifest SCC. In this report, we present a case of a 44-year-old woman with severe local recurrence of SCC in the right heel, four years after an initial excision of a primary, small lesion. For various reasons, the patient did not visit the clinic for follow-up assessment during this period. Considering the extent of the lesion and infection risk, the affected leg was amputated at one-third of the lower leg. This case report underlines the importance of educating patients about the risk of SCC and assisting them in attending follow-up visits. In addition, adequate attention should be given to foot lesions with suspicious appearance. Early detection would minimize systemic risks, including metastasis and infection, and maximize preserved function after surgical intervention.

Verrucous Carcinoma of the Foot - Report of Two Cases

Verrucous carcinoma (VC) is a rare variant of a well-differentiated squamous cell carcinoma (SCC) with a low grade of malignancy. Epithelioma cuniculatum (EC) is a subtype of VC, usually found on the sole of the foot.

Two patients, a 55-year-old female, and a 77-year-old male, with VC were treated at the Clinic of Dermatology and Venereology, Clinical Center of Serbia, from 2002 to 2011. Both patients presented with a tumor on the foot. Incisional biopsies showed a well differentiated squamous cell carcinoma. Foot x-rays showed bone involvement in one case. One patient underwent surgical amputation of the lower extremity, while the other had a partial amputation of the affected foot.

In the initial stage of the disease, it is difficult to distinguish pseudoepitheliomatous hyperplasia from verrucous carcinoma. The superficial biopsy of EC lesion may mislead to a histopathological diagnosis of warts or condylomas. Multiple deep biopsies are necessary for accurate and timely diagnosis of verrucous carcinoma.

Carcinoma cuniculatum: an atypical presentation in the foot

Carcinoma cuniculatum is a rarely occurring, low-grade variant of squamous cell carcinoma most commonly found in the forefoot. It should be suspected in the differential diagnosis for chronic nonhealing verrucous wounds. The initial diagnosis of carcinoma cuniculatum is difficult and often delayed and can require repeated histopathologic evaluation by an experienced pathologist. In many cases, the final diagnosis will be made from the microscopic findings correlated with the clinical examination findings. Metastasis from carcinoma cuniculatum is rare, although it can invade deep into the soft tissues and can extend to the bone. Wide local excision with a 5-mm tumor-free margin has been the recommended treatment. If the tumor extends into the bone, amputation might be warranted. The present report describes the case of an atypical carcinoma cuniculatum found in the hindfoot of an adult female and represents the surgical follow-up to the histopathologic description of the same patient's lesion as previously described in a published report.

Carcinoma cuniculatum: not a verrucous carcinoma

BACKGROUND

Carcinoma cuniculatum and verrucous carcinoma are both very well differentiated forms of squamous carcinoma and thus difficult to separate histologically from pseudocarcinomatous hyperplasia. The diagnosis of each often requires clinical-pathologic correlation.

METHODS

We reviewed the literature on cases reported as carcinoma cuniculatum and compared these to the cases originally reported by Aird et al. In addition, we report an additional case of this entity that we encountered in our practice.

RESULTS

In reviewing the literature it is evident that most authors consider carcinoma cuniculatum and verrucous carcinoma to be synonymous even though Aird's original two cases had no verrucous features. The lack of a clear conceptual distinction between these two entities may cause diagnostic confusion.

CONCLUSION

The purpose of this report is to record a case of carcinoma cuniculatum which the authors believe to be similar to those reported by Aird et al., to emphasize the differences between carcinoma cuniculatum and verrucous carcinoma, and to explain how the lack of a clear conceptual distinction between these two tumors can lead to further delay in an already difficult diagnosis.