-Progressive pallor, fibrosis, and marble-like rigidity of tissues usually beginning in soft palate and fauces, then involving buccal mucosa, lips and tongue

-Ulcers, areas of erythema, vesicles, petechiae, melanosis, xerostomia, and symptoms of burning usually first signs/symptoms; then dev marble-like pallor and progressive stiffness of subepithelial tissues

-Palpable fibrous bands run vertically down buccal mucosa in advanced lesions leading to reduction in mouth opening and trismus

CT shows dense, hypovascular collagen w/ varying # of inflammatory cells

Epithelium may show subepithelial vesicles, then hyperkeratosis, epi atrophy

Epithelial dysplasia present in 10-15% of cases; carcinoma in 6-8%

TX: Following biopsy to exclude dysplasia or carcinoma, mild cases may be treated with intralesional corticosteroids to reduce symptoms; surgical splitting or excision of fibrous bands

PX: must be following carefully for dev of epidermoid carcinoma - 8%

Most common after age 45; M/F up to 10:1

Slowly dev; atrophy of vermillion border, blurring of margin between vermillion and skin

Becomes scaly, dry, thick, leukoplakic, peeling, ulcerative

Epithelial atrophy, hyperkeratosis, varying degrees of epi dysplasia

Underlying CT shows band of amorphous, acellular basophilic change (solar or actinic elastosis) due to UV induced alteration of collagen and elastic fibers

Lip balm w/ sunscreen for mild cases

Surgical lip or laser ablation

6-10% dev epidermoid carcinoma, usually well-differentiated, usually after age 60

Self-limiting, epithelial proliferation w/ strong clinical and histopathologic similarity to well-differenctiated squamous cell carcinoma.

Known as well-differentiated form of SCC

Cutaneous lesions arise from infundibulum of hair follicles

Oral lesions are rare (some don't accept as intraoral disease)

Males mostly over 45

95% found on sun exposed skin

Firm, nontender, well-demarcated, sessile, dome-shaped nodule w/ a central plug of keratin

Most common malignancy of oral cavity (94%)

22,000 new cases/year in US; 5,300 die

SCC of lip not as aggressive, behaves more like SCC of skin

Increasing understanding, awareness, and avoidance of etiologic factors

WHERE PTs COME IN!

Candidal infection

Oncogenic viruses: HPV 16, 18, 31, 33; HPV 16 pos better prognosis than HPV neg; EBV esp in nasopharyngeal Ca; HSV evidence less compelling

Immunosuppression

Oncogenes and tumor suppressor genes (p53)

High index of suspicion leading to early diagnosis

THATS WHERE WE COME IN!

- US most common in older adults (exceptions)

Male to female: 3:1

Often painless and hides in dark places, leading to tragic delay in diagnosis and consequent advancement in stage before treatment

Can mimic other more harmless conditions

Exophytic (mass forming, fungating, papillary, verruciform)

Endophytic (invasive, burrowing, ulcerated)

Leukoplakic

Erythroplakic

Erythroleukoplakic

-Neoplastic islands, strands, sheets and individual cells invade underlying tissue including fibrous CT, muscle, nerves, and blood vessels

-Neoplastic epi characterized by all changes listed as dysplastic

-Neoplasms vary in differentiation from well to moderately to poorly to undifferentiated: well differentiated appears much like normal epi cells and tissue; undifferentiated very difficult to recognize

Most common: ipsilateral cervical nodes: stony hard, nontender, enlarged and may be fixed; occasionally contralateral or bilateral nodes; small % have distant metastasis: most commonly lungs, liver, bone but any site may be involved

SCC of lowerl ip and oral floor: submental nodes

SSC from posterior oral cav: superior jugular and digastric nodes, retropharyngeal nodes

Farther posterior primary, greater chance of local and distant metastasis

Degree to which histologically resembles its parent tissue (squamous epi) reflected in histologic grade (grade 1-3 or 4)

Can also be graded according to degree of differentiation (well, moderately, poor, undifferentiated)

Higher grade number (3 or 4) more poorly differentiated the tumor vice versa

Most reliable indicator of prognosis of most malignancies

TNM system used: T = size of primary tumor in cm; N = involvedment of local lymph nodes; M = presence of distant metastasis

Anterior 2/3s is wide surgical excision often following by radiation;chemo

Posterior 1/3 solely radiation w/ or w/out chemo

Lymph node dissection (radical neck dissection) may be done if involved clinically or risk of involvement is high

Overall 5-year survival of Oral SCC remains at 5-59%

Tends to be better anteriorly than posteriorly

Early detection can minimize advancement of cancer

Increased risk (6-44%) of getting other malignancies