Plantar verrucous carcinoma following transmetatarsal amputation and renal transplantation

Verrucous carcinoma is a rare, low-grade, well-differentiated squamous cell carcinoma that may occur anywhere on the skin. It is slow growing, enlarges relentlessly, and invades locally. Most cutaneous verrucous carcinomas are found on the plantar surface of the foot, and share many gross and histological characteristics common to the ubiquitous verruca vulgaris. It is not uncommon for verrucous carcinoma of the sole to be mistaken for the more common verruca plantaris. The case of a 53-year-old white male with plantar verrucous carcinoma following cadaveric renal transplantation, right popliteal-tibial bypass, and a right transmetatarsal amputation is presented. Treatment included reamputation followed by reconstruction with a free radial forearm fasciocutaneous flap. Verrucous carcinoma is a slow-growing but relentlessly invading tumor that is easily misdiagnosed. The extent of early resection is often inadequate. We must be aware that certain persistent 'warts' may represent a form of cancer that is treated differently from common verrucae or other squamous carcinomas.