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Oral malignancy necessitates early detection for a better prognosis. Clinical presentation may vary, from a small mucosal lesion with benign clinical features to a large ulcerated mass with considerable local destruction.
The case of a 46-year-old patient presenting to a dental access centre with upper quadrant jaw pain, parasthaesia and unexplained tooth mobility is discussed. Delay in recognizing key features suggestive of sinister pathology led to a seven-week delay in referral of an aggressive, rare, odontogenic malignancy; ameloblastic carcinoma. The patient underwent extensive surgery with adjunctive radiotherapy.
CPD/Clinical Relevance: Odontogenic malignancy can cause rapid and extensive local invasion with a high potential for local or regional spread. Maxillary tumours often present with late, non-specific symptoms, thus must be detected early.
Article
Oral malignancy carries a better prognosis with prompt diagnosis and treatment. The stage of the tumour at the time of diagnosis is related to survival. The overall survival rates are higher in patients with stages I or II cancer than those with stages III and IV cancer at the time of diagnosis.1
Reasons for delay in presentation can be multifactorial. Symptoms may be non-specific or occur late during the disease course and patients may defer consulting a healthcare professional, despite the onset of symptoms. A further factor is the time taken for a practitioner to recognize the adverse features of a suspected malignancy and thus make an appropriate, fast-track referral, usually to an oral and maxillofacial surgery department.2
Oral cancer remains a serious problem, comprising 6–7% of all malignant tumours worldwide and totalling approximately 300,000 new cases worldwide per year.3 Detection relies on a thorough intra- and extra-oral examination at every attendance. A differential diagnosis of cancer requires a detailed clinical history and examination, supplemented with adjunctive diagnostic tests, including radiographs.
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