Insights into incipient oral squamous cell carcinoma: a comprehensive south-american study

Abstract

Background: To describe demographic and clinicopathological aspects of a South-American cohort of incipient oral squamous cell carcinoma patients.

Material and methods: A cross-sectional, observational study was performed to assess demographic and clinicopathological characteristics of incipient oral squamous cell carcinoma patients from 6 South-American institutions.

Results: One hundred and seven patients within the histopathological spectrum of incipient oral squamous cell carcinoma (in-situ and microinvasive) were included. Fifty-eight (54.2%) patients were men with a mean age of 60.69 years. Forty-nine (45.8%) and thirty-nine (36.5%) patients had history of tobacco and alcohol use, respectively. Clinically, most of the lesions were plaques (82.2%), ≥ 2 cm in extension (72%), affecting the lateral border of the tongue (55.1%), and soft palate (12.1%) with a mixed (white and red) appearance. Eighty-two (76.7%) lesions were predominantly white and 25 (23.3%) predominantly red.

Conclusions: To the best of our knowledge, this is the largest cohort of incipient oral squamous cell carcinoma patients, which raises awareness of clinicians' inspection acuteness by demonstrating the most frequent clinical aspects of this disease, potentially improving oral cancer secondary prevention strategies.

Figure 1

Incipient oral squamous cell carcinoma cases with subtle clinical presentation. a) Homogeneous leukoplakia removed through excisional biopsy, resulting on a microinvasive OSCC; b) Erythroleukoplakia of the soft palate treated through excisional biopsy, showing in-situ OSCC; c) Mixed leukoerythroplakia with a diagnosis of in-situ OSCC; d) Microinvasive OSCC noticed as a small ulcer without indurated borders, affecting marginal gingiva; e) Small mixed lesion resulting in an in-situ OSCC: f) Nodular leukoplakia of lateral border of tongue with diagnosis of in-situ OSCC; g) Non homogeneous plaque situated on retromolar trigone, diagnosed as in-situ OSCC. Due to posterior localization and smaller size, the identification of this lesion could easily be overlooked by the patient or during a careless visual examination; h) Microinvasive OSCC presenting as a non-homogeneous speckled leukoplakia comprising the right side of the soft palate.

Figure 2

Histopathological spectrum of OSCCi cases (Hematoxylin and eosin). a) Severe epithelial dysplasia/in-situ carcinoma of the buccal mucosa showing atypia involving total thickness of the epithelium without basal membrane breach (10X); b) Leukoerytrhoplakia of the lateral border of tongue diagnosed as severe epithelial dysplasia/in-situ carcinoma. Lichenoid immune response is present in the subjacent connective tissue (10X); c) Non-homogeneous leukoplakia diagnosed as a severe epithelial dysplasia/in-situ carcinoma exhibiting bulbous rete processes and architectural disorganization (20X); d) Severe epithelial dysplasia/in-situ displaying architectural and cytologic atypia throughout total epithelium thickness (20X); e) OSCCmi showing keratinizing epithelial islands invading the subjacent connective tissue below 5 mm depth (20X); f) Basal membrane breach characterized by atypical basal cells showing loss of cohesion, as well as discrete small epithelial islands surrounded by chronic immune response (20X); g) Mixed lesion showing intense atypia and discrete microinvasive foci confined to the lamina propria (20X); h) Scarce epithelial cells showing cellular and nuclear atypia, focally branching outside the epithelium in a OSCCmi (40X).