Verrucous carcinomas have been aetiologically related to the use of chewing tobacco or snuff. The habitual chewing of "pan", a mixture of betel leaf, lime, betel nuts and tobacco has been implicated in the high incidence of VC of the oral cavity in India [197]. However, tobacco usage is not a reasonable explanation for VC in the skin, genitourinary tract and other non-aerodiges-tive sites [107].

A possible aetiologic factor is also human papilloma-virus (HPV), as HPV types 16 and 18, and rarely 6 and 11, have been found in some, but not all cases of VC [52, 56, 116, 172, 190].

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