PMC9931191_01
Clinical pictures: (A) Pre-operation image, an exophytic verrucous yellowish-to-whitish tumor occupying almost all the lower lip of approximately 5cm x 3cm2, resembling a cauliflower. (B) 30 days after surgical excision and double Abbe flap reconstruction, all skin lesions disappeared. (C) 30 months after surgery with a cosmetic appearance.
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The patient recently visited our department with an exophytic verrucous yellowish-to-whitish tumor occupying almost all the lower lip of approximately 5cm x 3cm2 ( Figure 1A ). No relapse was observed more than 30 months after surgery, with a superior cosmetic result and nearly no limitation of mouth opening ( Figures 1B, C ).
Pathological pictures: (A, B) Epithelial proliferation with verrucous appearance and significant keratosis, enlarged and fused endophytic epithelial ends with inflammatory infiltrate at the epithelial-stromal interface (H&E, x10, x40). (C) Endophytic papillae ending at different levels which forms pushing margins (H&E, x100). (D) At high magnification, the basal cells are actively proliferating, and the spinous cells are enlarged in size with keratosis and red staining cytoplasm (H&E, x100).
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No analogous lesions were identified elsewhere in the body, and a clinical diagnosis of verrucous carcinoma was verified by the deep biopsy ( Figure 2 ).
Reconstruction procedures: Rotating and insetting the double Abbe flap in the defect and suturing the distal edges of the two flaps to complete the repair of the defect.
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Two symmetrical flaps with full-layer incisions were made on the external sides of the philtrum column apart for rotation and inset, with the vascular connection reserved at the distal end ( Figure 3 ).