Slow to heal or slow to diagnose cancer?

Abstract

There are around 8,500 new cases of oral squamous cell carcinoma (SCC) diagnosed in the UK each year and the incidence appears to be increasing. Although surgical and non-surgical treatment options have improved significantly in the last few decades, five-year survival has not, with an average five-year survival of 56% in the UK. Providing patients have access, there are frequent opportunities for oral cancer screening by their general dental practitioner. We present two cases of SCC managed in our department, both of whom were referred following a protracted period of review in general dental practice, where the initial 'benign diagnoses' were not re-evaluated during this time. This delay can considerably impact on patient outcomes, including survival. We outline each patient's clinical course, and key learning points to help dental practitioners detect lesions that require prompt referral to the oral and maxillofacial service for urgent investigation.

Fig. 1

Squamous cell carcinoma right buccal mucosa. Speckled appearance and rolled margins. Note edentulous upper ridge where denture teeth were added

Fig. 2

Periapical radiograph of 23, 24, 25 and 26, irregular, severe bone loss associated with 24 and 25, with bone loss extending to mesial of 23

Fig. 3

Squamous cell carcinoma left maxilla. Ulcerative, mixed red and white destructive lesion, with erythema extending across the entire left hard palate

Fig. 4

An OPG radiograph showed a radiolucency on the ridge between the 23 and 26, with loss of antral base and generalised mild-moderate horizontal bone loss