Mistaken Diabetic Ulcers: A Case of Bilateral Foot Verrucous Carcinoma

Figure 3

Representative medium power image of the verrucous carcinoma demonstrates prominent surface hyperkeratosis and marked epidermal acanthosis, with a combined exophytic and endophytic growth pattern. Cytologic atypia is only mild to moderate. Rather than the infiltrative pattern typically seen at the deep edge of conventional invasive squamous cell carcinoma, verrucous carcinoma demonstrates insidious pushing-type invasion by expansile and irregular rete pegs (4x, H&E stain).