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Rapid response to:


A giant fungating tumour on the buttock

BMJ 2017; 356 doi: (Published 02 February 2017) Cite this as: BMJ 2017;356:i6440

Rapid Response:

Re: A giant fungating tumour on the buttock

Dear Dr Houghton,

Thank you for your comments. Verrucous carcinoma may enter the differential diagnosis when there are superficial fragments of a more squamoid seborrhoeic keratosis (SK) with a "church-spire" growth pattern and little basal cell proliferation. In the typical SK, the component cells are different from those typically seen in verrucous carcinoma; in the latter, they are large, very well differentiated squamous cells. The growth pattern, as the name suggests, is also verrucous and prominently exo-endophytic, with deep extension into the dermis. SKs are superficial lesions which do not extend deeply. The more common differential diagnosis for verrucous carcinoma is that of verruca vulgaris. The clinical picture is obviously very important, as there would have to be extensive invasive growth for a diagnosis of verrucous carcinoma to be considered. Although very large, this was a superficial lesion, so would not give rise to that differential.

I must acknowledge Dr Brigid Maguire, Consultant Histopathologist at East Kent Hospitals, for help with this rapid response.

Competing interests: No competing interests

01 March 2017
Chris Duhovic
Consultant Dermatologist