Oral Ulceration - NEOPLASM - SCC

Squamous cell carcinoma (SCC) is the most common malignancy of the oral cavity. These lesions often begin as mixed white or red lesions and occur most often on the tongue, floor of mouth, or soft palate. Later lesions will often involve irregular ulcers with indurated or heaped margins. These lesions are chronic and do not heal with time or immunosuppressants. Oral SCC most often presents as an ulcerative lesion but can also be exophytic, infiltrative, or verrucoid. Histologically, these lesions show typical malignant epithelioid cells with intracellular bridging and possible keratin production. Treatment of oral SCC generally involves wide local resection, radiation therapy, or both.

Clinically apparent metastases to cervical nodes will be found on presentation in about 30% of patients; the presence of occult nodes must be considered and addressed as well. Decision making in the workup of early SCC involves correlating the history and physical examination. Worrisome historical factors are the presence of risk factors of tobacco and alcohol use and lesions that have not healed for several weeks to months. Factors on examination are irregular ulcers with indurated or heaped margins and of course enlarged cervical nodes. Areas of leukoplakia in the oral cavity should generally be biopsied or carefully followed. Areas of long term erythroplakia, induration, or exophytic growth in the oral cavity should generally be biopsied immediately. A high degree of suspicion must be maintained to allow early diagnosis, as these malignant lesions may mimic lesions of lichen planus, pemphigus or pemphigoid, sialometaplasia, or even major aphthae.

Opportunistic screening of patients for oral cancer can be done in just a few minutes. Click HERE for the NIDCR oral examination protocol.

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Small SCC of lower vermilion border

Extensive SCC of lower vermilion border

Advanced SCC lower lip

Ulcer on lateral border of tongue

Ulcerating lateral margin of tongue

Homogenous leukoplakia

Carcinomatous tranformation

SCC on cheek

SCC on gingiva

SCC on buccal mucosa/lip

These images of oral pathology are copyright Dentalgain.org, Cork University Dental School and Hospital, and European Cancer Project.