Oral Malignancy and Pre-Malignancy

• over 90% of oral cancers are SCC
• Other types of oral malignancies?

  • melanoma
  • maxillary antral carcinoma
  • salivary gland malignancies
  • sarcomas
  • lymphoreticular neoplasms
• oral cancer is the 6th most common cancer in the uk
• less than 60% of patient with oral cancer survive 5 years or more
• areas for SCC:

  • hard palate 10%
  • soft palate/trigone area 30%
  • buccal mucosa 5%
  • gingiva 10%
  • tongue 45%
• what we can do?

  • prevention - risk factors eg smoking/drinking
  • early diagnosis
  • manage lesions with increased risk of malignancy
• smoking is dose dependent, 3 fold increases risk of oral cancer, second hand smoke increase risk of 60-80%
• alcohol risk is linked to amount of alcohol rather than type
• reduced risk with increased consumption of fruit and veg
• UV light linked with lip cancer
• HPV and HPV-16 increases risk
• identifying abnormalites:

  • listen
  • look
  • feel
• clinical features of OSCC?


  • crater like ulcer with raised, rolled edges, granular base
  • exophytic mass
  • white, red, speckled lesiomn
  • lump/ulcer with induration (hard texture)
  • non-healing extraction socket
  • lesions fixed to deeper tissues on mucos
  • lymph node enlarement
  • bone invasion
• how do we refer a SCC?


  • rego system
  • RAC referral
• suspicious features of white patch?


  • persistent solitary patch, no obvious cause
  • high-risk sites - FOM, ventrum of tongue, posterior buccal mucosa, soft palate
  • recent change in size
  • pain/altered sensation/discharge/bleeding
  • high density/speckling
  • exophytic
  • ulceration
  • lymphadenopathy
• suspicious white patches

  
• suspicious white patch

  
• oral ulcers suspicious?

  • >3 week of isolated ulcers with no obvious cause
  • granular base/papillary/nodular
  • persitent area of ulcers in lichen planus
  • altered sensation
  • haemorrhage
  • margins raised/rolled/hyperplastic
  • induration
  • lymphadenopathy
• malignant ulcerations

  
• oral swellings - suspicious?


  • isolated persistent lesion of unknown cause
  • rapid increase in size
  • no infective aetiology
  • pigmented lesions
  • ulceration on surface
  • bleeding
  • unduration
  • fixation to overlying/underlying
  • lymphadenopathy
• SCC

  
• salivary gland malignancy

  
• lymphoma

  
• pigmented lesions suspicious?

  • aetiology and duration unknown
  • raised lumpu lesion
  • uneven colour
  • irregular margins, satellite lesions
  • bleeding, crusted lips
  • lymphadenopathy
• malignant melanoma

  
• malignant melanoma

  
• oral premalignancy?


  • erythroplakia
  • leukoplakia
  • lichen planus
  • candidal leukoplakia
  • actinic cheilitis
• verrucous leukoplakia

  
• leukoplakia and SCC

  
• lichen planus and SCC

  
• chronic hyperplastic candidiasis and SCC

  
• other common oral premalignancies?

  • submucous fibrosis
  • syphilitic leukoplakia
  • discoid lupus erythematosus
  • dyskeratosis congenita
  • sideropenic dysphagia
  • lesions in immunocompromised pt
• submucous fibrosis

  
• management:

  • establish diagnosis - referral?
  • treat other infections/manage mucosal diseases
  • remove risk factors/exacerbating factors
  • during tx/post tx prevention, oh advice