Oral Cancer and Precancerous Lesions - Topic 3: Examples of Oral Cancers

3.1   Introduction

The following series of slides will give you practice in identifying key clinical features of oral cancer.

3.2   Actinic Cheilosis

This is not cancer of the lip, but dysplasia. This is called actinic cheilosis. It is considered a premalignant condition and is due to sun exposure. Remind your patients to use sunblock on their lips.

3.3   Actinic Cheilosis

This is cancer that started out like the previous photo, but was neglected. Now it is a crusty and desquamating area that will not heal. Upon biopsy, it was a cancer. The patient underwent a wedge excision and a lip shave procedure.

3.4   Cancer of the lateral border of the tongue

This is cancer of the lateral border of the tongue, on the posterior aspect, a very common site and easily examined if you pull out the patientís tongue by grabbing it with a 2 by 2 gauze with good illumination. Palpation is also an invaluable tool in evaluation of the mouth, because there will be sites you can feel better than observe.

3.5   Cancer of the lateral and ventral tongue

Here is another cancer of the lateral and ventral tongue. It was totally asymptomatic, and the patient did not even know she had it. Again, this is a reminder that cancer does not have to manifest with symptoms; we must go into the mouth and look for it! Induration is an important red flag upon palpation. The Surgeon Generalís document and the American Cancer Society  have good information on the signs and symptoms of oral cancer.

3.6   Cancer of the floor of the mouth

Here is a cancer of the floor of the mouth. This patient complained of pain, but he had not even looked under his tongue for a lesion. This one clinically could be described as an erythro-leukoplakia, and histologically turned out to be a squamous cell carcinoma. 

3.7   Ulcerative lesion of the floor of the mouth

Another ulcerative lesion of the floor of the mouth. This patient used a denture that impinged on this area, and she neglected this lesion, thinking it was a denture sore. Unfortunately, it was a cancer.

3.8   Actinic Cheilosis

The lingual frenum is not an uncommon site for oral cancer. Patients usually blame trauma against their incisors as the cause and may neglect it for a while. A lesion like this one must be biopsied promptly, unless there is a traumatic explanation.

3.9   Verrucous Carcinoma

This is verrucous carcinoma, an exophytic low-grade cancer that requires excision and usually has a relatively good prognosis. It has a strong correlation with previous use of smokeless tobacco products. The buccal mucosa is a common site for this lesion, but it an occur anywhere.

3.10   Smokeless Tobacco-induced Lesion

This is a photo of a smokeless tobacco-induced lesion. These lesions have a high incidence of verrucous carcinoma after many years of dipping or chewing. The wrinkled mucosa is opaque, whitish and somewhat dry. These are totally asymptomatic for the majority of patients.

3.11   Cancer of the hard palate and dorsal tongue

This tumor turned out in an unusual location. The hard palate and dorsal tongue are unusual sites for oral cancers, but here it is.

3.12   Cancer of the buccal mucosa

This is a patient with carcinoma of the buccal mucosa. She had no history of smokeless tobacco use but had a history of lichen planus. There is controversial data as to the premalignant potential of erosive lichen planus (ELP) of the mouth, but err on the side of caution, and refer ELP patients for frequent follow-up and early excision of suspicious-looking areas.

3.13   Cancer of the gingiva

Here is a tumor of the gingiva. The patient also wore a partial denture, and it was believed clinically to be a denture sore that would not heal. Three weeks later, a biopsy confirmed the diagnosis.

3.14   Cancer of the dorsal tongue

Here is a carcinoma of the dorsal tongue. In the past it was thought there was an association between syphilis and this type of tumor, but this is probably not accurate. In any case, if we were to see a tumor in this location, concomitant syphilis is usually ruled out by a blood test. Exposure to some chemicals has been linked to this as well, apparently due to direct contact with the mucosa of the dorsum or the tongue.