(BMJ)—A 28-year-old nonsmoker with no PMHx who didn't use alcohol presented with a painless lesion on her tongue. Exam: well-circumscribed, keratotic, exophytic lesion with shaggy, papillomatous surface without surrounding induration. Bx confirmed dx. What is it?
Pseudoepitheliomatous hyperplasia
Keratoacanthoma
Verruca vulgaris
Ackerman tumor
Chronic hyperplastic candidiasis
You are correct. Bx was consistent w/ verrucous carcinoma (VC), or Ackerman tumor. This uncommon tumor typically occurs in people >50 yo w/ hx of alcohol use and smoking. Presentation in this young healthy woman was unusual. VC has an excellent prognosis due to its benign indolent behavior. Metastasis to regional lymph nodes is very rare. The most appropriate tx is surgical excision. In selected pts where surgery is not possible, radio-tx may be attempted, but some authors have reported radiation-induced anaplastic transformation. This pt had a wide excision of the lesion.

BMJ Case Reports 2017; doi:10.1136/bcr-2017-219784