Clinical Review

Oral Lesions You Can’t Afford to Miss

Clinician Reviews. 2015 September;25(9):44-47,50-53,56

References

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LOOK FOR SIGNS THAT SUGGEST MALIGNANCYIn the United States, oral and pharyngeal cancers account for approximately 40,000 cases of cancer and 8,000 deaths each year.¹⁷ More than 90% of these are squamous cell carcinomas (SCCs); the remainder are mainly salivary gland tumors, lymphoma, and other infrequent cancers.¹⁸

SCC of the oral cavity most commonly occurs on the tongue but can develop in any site, presenting as mucosal ulcers, plaques, or masses that do not heal (see Figure 21). Tobacco and alcohol use are associated with up to 80% of cases of SCC of the head and neck.¹⁸ Some oropharyngeal SCCs are associated with human papillomavirus infection type 16.¹⁹

Potentially malignant oral lesions include leukoplakia and erythroplakia. Leukoplakia is a white patch or plaque of the oral mucosa that can’t be explained by any other clinical diagnosis (see Figure 22). These lesions are at risk for malignant transformation and may demonstrate dysplasia or frank SCC on biopsy.²⁰ Proliferative verrucous leukoplakia is a unique form of leukoplakia that is characterized by a wrinkled appearance that is often multifocal; the condition is associated with a higher risk for malignant transformation.

Erythroplakia is a red patch that similarly can’t be explained by another diagnosis. It has a very high risk for malignant transformation over time. All potentially malignant oral lesions, including leukoplakia and erythroplakia, require biopsy and careful monitoring.

Non-SCC cancers. Salivary gland tumors are rare and most commonly occur in patients ages 55 to 65. Most neoplasms (70%-85%) occur in the parotid gland, while 8% to 15% develop in the submandibular salivary gland and less than 1% involve the sublingual gland.²¹ Minor salivary gland tissue, especially in the lips and palate, may also be affected (see Figure 23). Patients present with circumscribed, fixed or movable, painless, soft or firm masses in a salivary gland.

Melanoma should be included in the differential diagnosis of oral pigmented lesions that have any features of cutaneous melanoma, such as asymmetry, irregular borders, or variable or changing color.²²

Hematologic malignancies may initially present (or demonstrate evidence of relapse) in the oral cavity. Leukemia typically presents with sheet-like overgrowth and swelling of the gingiva, with associated erythema and bleeding (see Figure 24), whereas lymphoma typically presents as a solitary mass or ulceration. Solid tumors that metastasize to the oral cavity may present with localized unexplained soft or hard tissue growths, with or without associated neurologic symptoms (eg, paresthesia).

MALIGNANCIES