DT U.S. Edition, October 2010, Vol. 5, No. 21

non-movable mass.1 However, OSCC often begin as white or red plaques of sur- face mucosa, making early clinical detection possible. If a leukoplakic or erythroplakic lesion appears in the oral cavity and does not heal within a few weeks, biopsy is rec- ommended for definitive diagnosis, which may represent levels of histo- logically normal tissue (e.g., kerato- sis) to atypia, dysplasia, carcinoma in situ or overt carcinoma.1 Papillary OSCC, such as the case presented here, is a variant of SCC as classified by the World Health Organization4 and can present as either in situ or invasive lesions.5 Male predominance exists in OSCC cases, and the sites most commonly affected in order of prevalence are the larynx, nasal cavity and oral cavity.2, 5 The clinical appearance of papil- lary OSCC often mimics other vari- ants such as verrucous carcinoma, which is included in a differential diagnosis until confirmation with microscopic examination and diag- nosis.3 Microscopically, OSCC can show invasive and disorganized growth with the following: dyskeratosis, keratin pearls and intercellular bridges, increased nuclear-to-cyto- plasmic ratios, nuclear chromatin irregularities, prominent eosino- philic nucleoli and increased mitot- ic figures with atypical formation. Perineural invasion can be seen in some lesions, presenting a positive correlation to metastatic potential.1 In this case presentation, many of the aforementioned microscopic features of OSCC were evident with- out evidence of perineural invasion. Early detection of OSCC, spe- cifically stage I or II diagnosis, is usually associated with a favorable prognosis. Papillary OSCC in gen- eral has a 70 percent, five-year sur- vival rate at any stage, and at T1 it carries a 100 percent survival rate6 compared to other variants, such as basaloid (40 percent, two-year sur- vival), adenosquamous (55 percent, two-year survival), and spindle cell (80 percent, five-year) carcinomas.2 Most reported cases of papillary SCC exhibit a mean diameter of 1 to 1.5 cm2 . Our patient presented with a relatively large lesion measuring topathologic evaluation revealed an exophytic, papillary prolifera- tion of surface mucosa showing marked maturational perturbations. It included cellular and nuclear pleomorphism, prominent nucleo- li, hyperchromatism, acantholysis, increased mitotic activity and abnor- mal mitotic figures, dyskeratosis and keratin pearls, and increased nucle- ar-to-cytoplasmic ratios. Invasive cords and islands of malignant mucosa were visualized and the associated connective tis- sue contained an influx of acute and chronic inflammatory cells. To evaluate whether the inflammatory infiltrates observed in the cancerous tissue were in response to super- imposed fungal infection (because organisms such as Candida albi- cans are common oral inhabitants), periodic-acid Schiff staining was conducted and determined to be negative with appropriate staining of control tissue. The patient was referred to the head and neck oncology group at the University of Southern California, Los Angeles County Hospital and Keck School of Medicine. Clinical work-up for staging was performed and computerized tomography scans of the head, neck and chest were determined to be negative for metastatic disease; the lesion was staged at T2N0M0. The patient underwent tumor resection with 1 cm margins and suprahyoid neck dissection, with no radiation or chemotherapy. Her postoperative course was unevent- ful, and histopathologic analysis confirmed a diagnosis of papillary OSCC. The dissected lymph nodes showed no metastatic involvement, confirming that the surgical mar- gins were tumor free. There was no clinical evidence of recurrence at 6-months follow-up. Discussion The typical presentation for OSCC can be either a symptomatic or asymptomatic mucosal ulcer. These superficial ulcers often progress into symptomatic or asymptomatic exo- phytic or endophytic nodules with eroded or ulcerated surfaces, and can progress to direct invasion of the deeper structures resulting in a firm, over 3 cm in diameter. Dentists have a critical role in early identification of and effective care during OSCC progression from premalignant lesion to malignan- cy.7 A study conducted to evaluate the effectiveness of dentists in the early detection, treatment and post- operative care of OSCC in a central European population revealed the following results: Dentists identi- fied 72.5 percent of the tumors in the 608 patients they saw as malig- nant, while family physicians did DENTAL TRIBUNE | OctOber 2010 Clinical 7A so in only 40.11 percent of their 406 patients. This difference was statisti- cally significant (P < .001).8 OSCC is a major public health problem that is not just limited to certain risk groups, such as those who smoke and drink as in this case report. Early detection and identifi- cation of OSCC is critical to patient treatment and survival. DT A complete list of references is available from the publisher AD About the authors Paul C. Lee, BA; Justin Olsen, BS; and Joshua Adcox, BS, are den- tal students at the Herman Ostrow School of Dentistry of USC, Universi- ty of Southern California, Los Ange- les. Parish P. Sedghizadeh, DDS, MS, is an assistant professor at the Herman Ostrow School of Dentistry of USC, University of Southern Cali- fornia, Los Angeles. For correspondence: Paul C. Lee 925 West 34th Street, DEN 4110 University of Southern California, School of Dentistry Los Angeles, Calif. 90089-0641 E-mail: chong.lee@usc.edu Fig. 2: Histopathologic evaluation demonstrates abnormal mucosa with a micropapillary surface mor- phology and marked maturational perturbations in association with acute and chronic inflammatory cells (H&E, 20x original magnifica- tion). Fig. 3: Histopathologic evaluation reveals invasive islands and cords of malignant epithelium in addition to dyskeratosis and early keratin pearl formation (H&E, 20x original mag- nification). Fig. 4: Histopathologic evaluation of invasive cords of mucosa at high power magnification shows cellular and nuclear pleomor- phism, hyperchromatism, acan- tholysis, dyskeratosis, prominent nucleoli and increased nuclear- to-cytoplasmic ratios (H&E, 40x original magnification).