Clinical vignette A 56-year-old man was referred by his dentist with noticeable worsening of lingual vitiligo, who had been diagnosed with oral leukoplakia 3 years previously and was being followed up at the dental clinic. The patient had no significant medical history. He had a continuous smoking habit for more than 36 years but did not consume alcohol. The examination confirmed oral leukoplakia , with an irregular and rough surface, and a white papillary mass was observed within the area of leukoplakia on the right edge of the tongue (Figure 1). No swelling of the lymph nodes in the neck was observed. Biopsy of the lesion confirmed that it was a squamous cell carcinoma . CT scan, MRI, and ultrasound showed that the mass was confined to the surface of the tongue. |
Figure 1 : White lesions were observed on the right edge of the tongue. Proliferation of papillary cells was observed in the same area .
Treatment and follow-up
Resection of the mass with at least 10 mm of surrounding tissue was performed under general anesthesia. During surgery, a quick pathological diagnosis was made to confirm that there were no tumor cells left and the wound was subsequently sutured.
After the operation, slight tongue deformation and scarring were noted, which affected the patient’s feeding, swallowing, and pronunciation, but these functions gradually improved.
Five years after surgery, the patient’s clinical evolution was favorable, with no recurrence.
Premalignant oral lesions
Tongue cancer accounts for 60% of all oral cancers and usually starts on the edge of the tongue. Nearly 90% of all oral cancers are squamous cell carcinomas , and the main risk factors are chronic irritation, smoking, and alcohol consumption.
Most oral cancers have a premalignant lesion stage . Regular monitoring of the progression of premalignant lesions is essential for the early detection and treatment of oral cancer.
Oral leukoplakia , the most common potentially cancerous oral lesion, progresses to squamous cell carcinoma at a rate ranging from 0.1% to 36.4%. This transformation depends on factors such as sex, age, clinical type, locus, mode of onset, and the presence or absence of epithelial atypia, although the mechanism is unclear to date.
Currently, there are no clear guidelines on whether aggressive resection or monitoring progression produces better outcomes. Consequently, there is an urgent and unmet need for molecular biological investigation of leukoplakia.
Importance of regular monitoring
Our report illustrates the importance of regular monitoring for leukoplakia. Before our patient presented, he had been followed regularly by his dentist, and this led to earlier recognition of possible malignant transformation, resulting in earlier resection of the cancer and a better prognosis.
