Part 2 - Malignancies of surface epithelial origin (test 1)

Question 1

Tell me about Squamous cell carcinoma in the floor of the mouth.

Answer 1

It’s a site for SCCa that’s almost as common as the lateral tongue, usually shows up near the midline and most patients with it have a history of cigarette smoking and alcohol.

Question 2

Tell me about Squamous cell carcinoma in the gingiva/alveolar mucosa.

Answer 2

It’s an unusual site for oral SCCa, it’s more common in women (2:1), More common in patients with no identifiable risk factors

Question 3

Tell me about Squamous cell carcinoma in the buccal mucosa.

Answer 3

Not a very common site for oral SCCa.

Question 4

Tell me about Squamous cell carcinoma in the palate.

Answer 4

Usually on the lateral soft palate, rarely on hard palate, difficult to determine whether lesion developed in the maxillary sinus and invaded through the floor

Question 5

What is the clinical differential diagnosis for squamous cell carcinoma?

Answer 5

• Non specific ulcer
• Specific infections: TB, Syphilis, Deep Fungal (histoplasmosis)
• Immune mediated conditions: Wegner’s granulomatosis, Crohn’s disease

Question 6

How does squamous cell carcinoma look radiographically?

Answer 6

• Visible in late stages due to direct invasion of bone.
• Ragged moth eaten radiolucency
• Ill-defined borders
• Pathologic fracture is possible

Question 7

What is the histopathology of squamous cell carcinoma?

Answer 7

• Microscopically, invasive cords and nests of malignant squamous epithelial cells arise from dysplastic surface epithelium.
• Tumor cells show an increased nuclear/cytoplasmic ratio, cellular nuclear pleomorphism, and mitotic activity
• Varying degrees of keratin production may be seen (well vs. poorly differentiated)

Question 8

What are the treatments of oral squamous cell carcinoma?

Answer 8

• Wide surgical excision and/or radiation therapy
• Chemotherapy has not shown much impact
• Neoadjuvant therapy to shrink the tumor initially
• Molecular-based targeted therapies are anticipated for the future

Question 9

What is the prognosis of oral squamous cell carcinoma?

Answer 9

• Generally poor because most patients present in Stage III or IV
• Metastasis to regional lymph nodes
• At 60% 5-year survival, one of the worst prognoses of any major cancer
• Periodic follow-up examination after tx is necessary
• From 10-25% of these patients will develop new upper aerodigestive tract malignancies tract malignancies, particularly if carcinogenic habits are continued

Question 10

Tell me about verrucous carcinoma.

Answer 10

• It’s a less aggressive, relatively uncommon form of squamous cell carcinoma.
• Usually develops in elderly male patients
• Smokeless tobacco is often mentioned as a contributing factor, particularly in some southern states, women who use dry snuff

Question 11

Tell me about the appearance of verrucous carcinoma.

Answer 11

• It’s a diffuse white or mixed red/white plaque
• Alveolar mucosa, hard palate and buccal mucosa are the most frequent sites
• It tends to grow laterally
• Microscopically is appears very bland (often misdiagnosed). Diagnosis is based on the overall tumor, not individual cells

Question 12

What is the treatment of verrucous carcinoma?

Answer 12

• Surgical excision
• Radiation is discouraged due to reports of verrucous carcinoma transforming to a more aggressive squamous cell carcinoma (recent studies suggest these effects are over exaggerated)