Etiology • Majority (approximately 80%) related to tobacco and alcohol
abuse • Some cases may be virus associated (human papillomavirus
types 16 and 18) • Stepwise progression of genetic alterations now defined from
normal to dysplasia to carcinoma
Clinical Presentation • Early, usually a white or red-white focal surface alteration • Later stages with ulceration, induration, elevated margins • Most common sites: lateral tongue, floor of mouth • Lower lip vermilion surface also a common location • Advanced-stage disease has associated limitation of movement,
trismus, cervical lymph node metastases
abuse • Some cases may be virus associated (human papillomavirus
types 16 and 18) • Stepwise progression of genetic alterations now defined from
normal to dysplasia to carcinoma
Clinical Presentation • Early, usually a white or red-white focal surface alteration • Later stages with ulceration, induration, elevated margins • Most common sites: lateral tongue, floor of mouth • Lower lip vermilion surface also a common location • Advanced-stage disease has associated limitation of movement,
trismus, cervical lymph node metastases
Radiographic Findings • May erode or invade adjacent bone in later stages • Irregular, destructive, ill-defined margins in later stages
Microscopic Findings • Usually well differentiated to moderately differentiated • Invasive islands, cords of epithelial cells • Individual cells with nuclear pleomorphism, increased nuclear-
to-cytoplasmic ratio, dyskeratosis • Architectural disorganization of proliferating cells
Diagnosis • Microscopic analysis of tissue specimen (biopsy)
Differential Diagnosis • Chronic traumatic ulcer • Primary syphilis • Deep fungal infection • Palatal necrotizing sialometaplasia • Keratoacanthoma (labial)
Treatment • Surgical excision is the treatment of choice. • Combined surgery and radiation therapy for more advanced-
stage lesions • Adjuvant chemotherapy plays a role in advanced disease.
Prognosis • Results are stage related as follows:
• Stages 1 and 2: generally good prognosis • Stages 3 and 4: generally fair to poor prognosis