Penis & scrotum

Squamous cell carcinoma and variants

HPV independent squamous cell carcinoma

Verrucous carcinoma

Last author update: 1 May 2010
Last staff update: 28 October 2020

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PubMed Search: Verrucous carcinoma[TIAB] penis

Alcides Chaux, M.D.
Antonio L. Cubilla, M.D.
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Cite this page: Chaux A, Cubilla AL. Verrucous carcinoma. website. Accessed June 2nd, 2023.
Definition / general
  • Verruciform, slow growing, extremely well differentiated variant of squamous cell carcinoma with low malignant potential
  • ICD-O: 8051 / 3
  • Also called Buschke-Löwenstein tumor
  • Glans is the preferred site but there is occasionally extension to other compartments
  • Tends to be multicentric in foreskin
Clinical features
  • Many cases classified as verrucous carcinoma could be reclassified as other verruciform neoplasms
  • Slow growing but may recur locally
  • No inguinal nodal metastases and no death due to disease in pure verrucous carcinoma
Gross description
  • Broad based white to gray exophytic neoplasm with a verruciform pattern of growth
  • Invasion is usually limited to lamina propria or superficial corpus spongiosum
Gross images

AFIP images

Large, destructive,
mass has extensively
replaced the penis

Papillary lesion involving the glans

Microscopic (histologic) description
  • Very well differentiated with prominent intercellular bridges, minimal atypia and rare mitotic figures
  • Penetrates through lamina propria with broad base and pushing borders
  • Hyperkeratotic and acanthotic papillae with keratin cysts
  • Orthokeratosis more prominent than parakeratosis
  • Tumor cells are polygonal squamous cells with glassy cytoplasm, central vesicular nuclei and intercellular edema; may have superficial vacuolated clear cells but no koilocytosis
  • Dense inflammatory infiltrate may obscure tumor stroma boundary
  • Intraepithelial abscess and crust formation is common
  • Frequently associated with squamous hyperplasia and differentiated penile intraepithelial neoplasia
  • Central fibrovascular cores are uncommon
Microscopic (histologic) images

Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.

Mixed (hybrid) usual - verrucous carcinoma

Exophytic growth


AFIP images

Pronounced exophytic tumor

Sharp interface
neoplasm and
lamina propria

Tumor cells have bland cytologic features

Negative stains
Differential diagnosis
  • Giant condyloma: conspicuous koilocytosis, prominent fibrovascular cores
  • Hybrid verrucous carcinoma: foci of usual squamous cell carcinoma intermingled with a typical verrucous carcinoma
  • Papillary carcinoma: invasive and jagged border, more atypia, irregular but usually evident fibrovascular cores
  • Squamous hyperplasia: no atypia, no stromal reaction and no extension beyond lamina propria (in some cases distinction is not possible)
  • Warty carcinoma: koilocytotic change present, jagged tumor front, neoplastic cells with more pleomorphism, prominent fibrovascular cores and usually deeper invasion
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