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Cancers of the Oral Mucosa Differential Diagnoses

  • Author: Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC); Chief Editor: Dirk M Elston, MD  more...
 
Updated: Feb 12, 2016
 
 
 
Contributor Information and Disclosures
Author

Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC) Emeritus Professor, University College London; Visiting Professor, Universities of Athens, BPP, Edinburgh, Granada, Helsinki and Plymouth

Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC) is a member of the following medical societies: Academy of Medical Sciences, British Society for Oral Medicine, European Association for Oral Medicine, International Academy of Oral Oncology, International Association for Dental Research, International Association for Oral and Maxillofacial Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

John G Albertini, MD Private Practice, The Skin Surgery Center; Clinical Associate Professor (Volunteer), Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine; President-Elect, American College of Mohs Surgery

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery

Disclosure: Received grant/research funds from Genentech for investigator.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kelly M Cordoro, MD Assistant Professor of Clinical Dermatology and Pediatrics, Department of Dermatology, University of California, San Francisco School of Medicine

Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Medical Society of Virginia, Society for Pediatric Dermatology, Women's Dermatologic Society, Association of Professors of Dermatology, National Psoriasis Foundation, Dermatology Foundation

Disclosure: Nothing to disclose.

References
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Oral squamous cell carcinoma in the most common intraoral site manifesting as a chronic, indurated ulcer.
Early oral squamous cell carcinoma in the buccal mucosa arising from a chronic candidal leukoplakia in a person who smokes heavily. The lesion was a painless, chronic indurated lump.
Cancer developing on the gingiva.
Cervical lymph node metastasis from oral cancer.
Table 1. Practical Clinical Tool for Evaluating Oral Mucosal Lesions
Issue No Serious ConcernConcern: Consider Referral to Specialist if Clinician or Patient Concerned, Especially if Multiple Issues ApplySerious Concern: Referral to a Specialist
Historical FeaturesSizeNo changeNo reduction in size, even after eliminating trauma to lesion after 10-14 daysIncreasing size, even after eliminating trauma to lesion after 10-14 days
 ChronologyLesion healsNo resolution over brief observation periodRapid symptom onset



Solitary lesion or change in one area of lesion



Lesion persisting 3 weeks or longer



Persistent ulceration



Persistent swelling



Loosening of a tooth



Nonhealing tooth extraction socket



 NeurologicalNoneLack of painPain



Dysphagia



Odynophagia



Otalgia



Numbness/paresthesia



Speech or voice change



 WeightNormalNo weight lossWeight loss
HistoryLifestyle HabitsNoneTobacco consumption mild/moderate



Betel quid or khat consumption mild/moderate



Marijuana consumption mild/moderate



UV light exposure mild/moderate (lip surface exposure



Late-onset sexual debut



Few or moderate numbers of lifetime sexual partners



Tobacco consumption high



Betel quid or khat consumption high



Alcohol consumption high



Marijuana consumption mild/moderate



UV light exposure high



Early sexual debut



Numerous lifetime sexual partners



 Medical HistoryClearDeficiencies of iron or vitamins A, C, or E



Diabetes



Discoid lupus erythematosus



Dyskeratosis congenita



Epidermolysis bullosa



Fanconi anemia



High-risk human papillomavirus infection Immune defects, including HIV/AIDS or chronic candidosis



Medications: Immunosuppressants, antihypertensives



Periodontitis, poor hygiene



Plummer-Vinson syndrome



Scleroderma



Xeroderma pigmentosum



Deficiencies of iron or vitamins A, C, or E



Diabetes



Discoid lupus erythematosus



Dyskeratosis congenita



Epidermolysis bullosa



Fanconi anemia



High-risk human papillomavirus infection



Immune defects, including HIV/AIDS or chronic candidosis



Medications: Immunosuppressants, antihypertensives



Periodontitis, poor hygiene



Plummer-Vinson syndrome



Scleroderma



Xeroderma pigmentosum



Examination and ImagingPotentially Malignant DisorderNoneLeukoplakia



Lichen planus/lichenoid mucositis



Oral submucous fibrosis



Erythroplakia



Leukoplakia; speckled or verrucous



Lichen planus/lichenoid mucositis; unilateral



 Lesion FeaturesEquivocalWhite patch (leukoplakia)



Lichen/lichenoid



Oral submucous fibrosis



Red patch (erythroplakia)



Mixed red and white patch (erythroleukoplakia/speckled leukoplakia)



Granular surface



Rolled, elevated margins



Ulceration



Induration



 Cervical Lymph NodesNo enlargementPossible enlargementEnlarged, firm, fixed, nontender, asymmetric
 ImagingNo abnormalityAny bone density changePoorly defined, uncorticated, irregular radiolucency



Lamina dura loss



Teeth displaced and/or resorbed



Pathological fracture



Table 2. Targeted Therapies for Oral Cancer and Oral Adverse Effects
TherapiesExamplesAdverse effects
EGFR inhibitors (FDA approved)CetuximabUlcers
EGFR inhibitorsPanitumumab, erlotinib in combination with gemcitabineUlcers
mTOR inhibitorsDeforolimus, rapamycin (sirolimus) and temsirolimusUlcers
Tyrosine kinase inhibitors (TKIs) of platelet-derived growth factor (PDGF)ImatinibUlcers, dysgeusia
TKIs of PDGF and vascular endothelial growth factor (VEGF)SunitinibUlcers, dry mouth, dysgeusia
Raf multi-kinase inhibitorsSorafenibDysgeusia
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