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Oral squamous cell carcinomas (SCC) may present with similar signs and symptoms of common conditions of the oral cavity. Even for experienced clinicians, this can make diagnosis challenging and delayed. With a reported 2.5% increase in death for every week that diagnosis, and therefore treatment, is delayed, early diagnosis is imperative. We report a diagnostically challenging case of a 47-year-old fit and healthy male patient who presented with a non-healing socket following the extraction of a misdiagnosed periodontally involved mandibular third molar. Following multiple visits to both primary and secondary care, alongside various investigations, eventually a diagnosis of SCC of the mandibular alveolus was established.
CPD/Clinical Relevance: This case raises awareness of the varied presentations of oral SCCs and the importance of considering a malignant cause despite the presentation being similar to that of common oral conditions, such as a non-healing socket.
Article
Oral cancer is the sixth most common cancer worldwide, with squamous cell carcinomas (SCC) accounting for up to 95% of cases.1 Prognosis of oral SCCs is solely dependent on the stage of diagnosis, and dentists play a fundamental role in early detection of oral SCCs.2 The tongue is the site most commonly affected, followed by the floor of the mouth, but other sites, such as the buccal mucosa, gingivae, palate and retromolar region, may also be affected. Oral SCCs may present clinically as leukoplakia or erythroleukoplakia, both of which may develop into an ulcer with irregular indurated borders or an exophytic mass.3
Dentists tend to be very well versed in recognizing when a non-healing ulcer or white patch may indicate SCC. In these situations, referral to secondary care for further investigations is often undertaken in a timely manner, allowing prompt commencement of treatment. Confusion may occur when an SCC presents with similar signs and symptoms of other common benign conditions. These may include but are not limited to pain, swelling, mobile teeth or gingival inflammation4. Malignant causes may be overlooked, and more familiar diagnoses may be favoured. This has been estimated to delay a diagnosis of SCC of up to 11 weeks5,6. With a reported 2.5% increase in death for every week diagnosis and therefore treatment is delayed, early diagnosis is imperative7.
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