7. Staging and diagnostic clinical aids

Conventional oral exploration (visual and palpation examination) constitutes the current gold standard for oral cancer screening, while biopsy and histopathological examination are indispensable for case detection. There are also a number of other techniques, that may contribute to the diagnosis of oral cancer, discussed below.

The accurate diagnosis of potentially malignant and malignant oral lesions depends on the quality of the biopsy, adequate clinical information, and correct interpretation of biopsy results (Figure 1).

Oral biopsy is discussed in Article 5. Specimens can be affected by crushing, fulguration, injection, or incorrect fixation and freezing. There is controversy regarding incisional versus excisional biopsy and surrounding the use of the most appropriate surgical instruments. Excisional biopsy is theoretically preferable because it allows histopathological examination of the entire lesion, but it risks incomplete treatment of malignant lesions and overtreatment of benign ones. It has been suggested that neck metastasis from OSCC may increase after incisional biopsy because tumour cells appear in the peripheral blood 15 minutes after incisional biopsies using a conventional scalpel. Other means of obtaining biopsy material might minimize seeding of cells. Electrocautery or CO₂ laser, however, can produce thermal cytological artefacts.