Oral cancers are malignant neoplasias that arise on the lip or within the oral cavity. The malignant lesion may originate as a primary lesion, as a metastasis from a distant organ, or by extension from a proximate site. Early symptoms include nonhealing ulcers, indurated areas, erythematous or white patches, swelling or enlargement, discolorations, dental mobility, hoarseness, and oral bleeding. If the lesion goes undetected, the symptoms can progress to airway obstruction, paresthesias of the tongue, otalgia, trismus, lymphadenopathies, blurry vision, and persistent pain.
Management and Disposition
Detailed head and neck examination is fundamental for the diagnosis of the lesion. CT scan may be helpful to establish a tentative diagnosis, but biopsy of the area is necessary to confirm the diagnosis. An incisional biopsy can be surgically performed with a #15 blade or biopsy punch and stored on 10% neutral buffered formalin medium for submission to pathology. A prompt referral to ENT or oral surgery is strongly recommended for further treatment. A combination of surgery, chemotherapy, and radiation is frequently used for definitive treatment.
Squamous Cell Carcinoma of the Tongue. Squamous cell carcinoma on lateral border of the tongue; this is the most common site for intraoral cancers. (Photo contributor: Michael T. Brennan, DDS, MHS.)
Squamous Cell Carcinoma of the Tongue. Patients may present with advanced lesions. Note the ulcerations on the superior aspect of this malignant tongue mass. (Photo Contributor: Lawrence B. Stack, MD.)
Squamous Cell Carcinoma of the Palate. Ulcerated lesions involving the hard and soft palate consistent with squamous cell carcinoma. (Photo contributor: Michael T. Brennan, DDS, MHS.)
Lingual Lymphoma. This patient had metastatic lymphoma, with unfortunate and extensive involvement of the tongue. (Photo contributor: R. Jason Thurman, MD.)
Early diagnosis and treatment remain the key to improving survival of patients. Questionable lesions should be urgently referred for appropriate follow-up and definitive diagnosis.
CT scan and biopsy of the area are necessary for diagnosis but may generally be performed on an outpatient basis.