Tackling Oral Giants: A Case of Verrucous Carcinoma Involving the Buccal Mucosa and Maxilla

Verrucous carcinoma (VC) is an uncommon, well-differentiated variant of squamous cell carcinoma (SCC) with a locally aggressive yet non-metastatic nature. It primarily affects the oral cavity, particularly the buccal mucosa, lips, and hard palate. Clinically, it presents as an exophytic, warty, or cauliflower-like lesion that can be misdiagnosed due to its resemblance to non-neoplastic ulcerative conditions. Histopathologically, VC exhibits pronounced keratinization, hyperplastic epithelium, and a test-tube-like growth pattern without significant nuclear atypia or metastasis. This case report describes a 41-year-old male presenting with a persistent ulcero-proliferative lesion diagnosed as VC. Surgical management included wide local excision, supra-omohyoid neck dissection, and partial maxillectomy with marginal mandibulectomy, utilizing a lower lip split apron flap for optimal access and minimal scarring. The defect was reconstructed with an anterolateral thigh (ALT) flap. The case highlights the necessity for precise diagnosis, an interdisciplinary approach, and the importance of surgical strategies to achieve optimal treatment outcomes in VC patients.