Date Published: November 11, 2008
Publisher: Public Library of Science
Author(s): Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio
Abstract: Luca Pastore and colleagues discuss the differential diagnosis and management of a 62-year-old man who presented with a 6-cm fungating mass on the dorsum of the tongue.
Partial Text: In May 2007, a 62-year-old man presented with a 6-cm fungating mass on the dorsum of the tongue (Figure 1), which had lasted for an unknown period of time. The lesion had a roughened and irregular surface, with areas of white keratosis admixed with areas of necrosis. It felt indurated on palpation. Two additional smaller exophytic lesions were observed on the dorsum of the tongue: one adjacent to the main mass and the other on the apex. Both showed surface nodularity and minimal surface keratin production. The surrounding mucosa demonstrated hyperkeratosis and a pebbled surface. Interlacing white keratotic striae were observed on the right buccal mucosa (Figure 2), while the mucosa of the left cheek had an erosive area bordered by fine, white radiating striae (not shown in figure).
Oral cancer is a global health problem; worldwide, nearly 275,000 patients are annually estimated to have oral cancer, which represents about 3% of all malignancies in men and 2% in women . The vast majority of oral cancers (approximately 94%) are squamous cell carcinomas that arise from the epithelium of the oral mucosa . Survival of patients with oral cancer is directly related to the stage of disease at diagnosis; in fact, the five-year relative survival rate increased from 26.5% for oral cancers diagnosed at a distant stage to 81.8% for cases diagnosed at a localized stage . Squamous cell carcinomas of the tongue seem to have lower rates of overall survival compared with cancers located in other oral cavity sites . Unfortunately, only 33% of oral cancers are diagnosed at a localized stage, when the disease may be more easily and successfully treated . This fact is responsible for a relatively poor overall five-year survival rate (59.1%), which has not significantly improved in the past several decades . As a consequence, early detection is critical to reduce oral cancer mortality. In 9% to 25% of patients with oral cancer, additional synchronous or metachronous primary oral or pharynx carcinomas develop ; for these patients, the survival rates are worse.