Low grade varient (1-10% of cases) or oral SCC

Many cases associated w/ use of smokeless tobacco

Males over 55

Most common sites: mandibular vestibular, gingiva, buccal mucosa, tongue and hard palate; smokeless tobacco users site of VCA often corresponds to where they keep tobacco

Diffuse, well-demarcated painless, thick plaque w/ papillary surface projections; most often white

May destroy underlying bone, cartilage, muscle, salivary glands

May arise adj to area of leukoplakia or tobacco induced keratosis

May also arise in previously existing proliferative verrucous leukoplakia (PVL)

Presents deceptively benign microscopic features: looks like widespread papillomatosis

Surface of epi is markedly papillary and shows marked hyperkeratosis w/ parakeratin plugs b/t epi clefts

Spinous later thickened but few if any cytologic or morphologic features of dysplasia

Deep margins of epi pushy rather than sharp or invasive

Dense lymphocytic infiltrate in superficial CT

Treatment and prognosis of Verrucous Carcinoma

Wide surgical excision; better than conventional SCC

Proper treatment 5-year disease free survival 90%

Uncommon but sinister type of cancer

Large empty space of antrum allows tumor to grow to adv stage before any signs or significant symptoms appear

Older adults; slightly more male

80% of cases are clinically adv stages

S&S: chronic unilateral nasal stiffness, ulceration or mass of hard palate or alveolar bone; involvement of V2 may cause intense pain or paresthesia of midface or maxilla simulating toothache; loosening of teeth

May be moth-eaten destruction of lamina dura of involved teeth & surounding bone, cloudy sinus and destruction of its bony wall

Perforation of lateral wall of sinus may cause unilateral facial swelling; medial extension can cause nasal obstruction or hemorrhage; superior extension can cause displacement or protrusion of eyeball

TX: hemimaxillectomy if tumor confined w/in sinus

PX: poor - 5 yr survival rate approx 40% if no node mets at initial present. 8% w/ nodes or involvement of pterygo fossa

Men more affected (2:1/3:1)

Can include nasasl cavity, max sinus & ethmoid sinus

Nasal obstruction, epistaxis, swelling & pain

trabeculae, ribbons, sheets and nests of polygonal cells w/ minimal cytoplasm and pleomorphic, hyperchromatic to vesciular nuclei.

Tumor necrosis, apoptosis, and lymphovascular invasion prominent

Complete surgical resection

if needed w/ chemo and/or radiation

Prognosis poor of 5 yr survival less than 20%

Definition of nasopharnygeal carcinoma

Group of malignancies arise from lining epi of lymphoid tissue-rich nasopharynx: similar tumors found in palatine tonsils and base of tongue

Found in Waldeyer's tonsillar tissue or Waldeyer's ring

SCC

Differentiated nonkeratinizin carcinoma

Undifferentiated nonkeratinizing carcionma

radiotherapy

Px ranges from good to poor depending on stage of disease

Malignant neoplasm arising from basal cells of epi of skin and its appendages

Most common (80%) type of skin cancer

Locally invasive but slowly spreading

Most commonly assoc w/ chronic exposure to UV radiation

Adult caucasians

Over 40

80% skin of H&N

Begins as firm, painless papule that slowly enlarges and gad dev a central depression and umbilicated appearance - central depression surrounded by a raised rolled border on surface of which are telangiectatic blood vessels

Untreated it slowly enlarges, eroding any soft tissue, bone or cartilage in its way ('rodent ulcer')

Often pigmented

Islands and strands of basiloid epi cells, periphery of which show nuclear palisading & esp hyperchromatic nuclei

Islands invade varying distances into underlying CT

Smaller leasions surgical excision; 95% cure rate

Larger lesions Mohs micrographic surgery; can recur due to inadequate margins, invasion of deeper tissue such as cartilage or bone

Familial hx : 2-8 x greater chance

Variety of genetic alterations

Light complexion, light hair, tendency to sunburn easily

UV radiation in form of acute sun damage

3rd most common skin cancer, accounts for most of skin cancer deaths

91% arise on skin, 5% on eye, 1% mucosal, 2% unknown

over 50% occur in H&N area

Oral mucosal melanoma is rare

Caucasian adults 50-55

ABCDE system of evaluation (asymmetry Border irregularity, Color variegation (brown, black, white, red, blue), Diameter greater than 6 mm, Evolving)

4 types: superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, acral lentiginous melanoma (most common in blacks and form of oral melanoma)

2 directional growth radial and vertical

Most common 6 or 7 decade; 2/3 men

80% located on hard palate or max alveolus

Begins as brown to black macule w/ irregular borders extends laterally and then dev a lobulated exophytic mass (vertical growth)

Ulceration may dev early, but many lesion are dark, lobulated, exophytic masses w/out ulceration at time of diagnosis

>20% little pigment

Pain not common unless ulcerated; most remain soft

Underlying bone may show moth-eatin destruction

Atypical melanocytes seen initially at epithelial/CT junction

Proliferate in 3 directions - surfaceward into epi, laterally along basal layer & deeply into underlying CT

INDV melanocytes can be epithelioid, spindle-shaped or anything in between; can be pleomorphic and mimic many other types (great imitator)

Oral melanomas tend to invade lymphatics & blood vessels more readily than skin lesions

Wide surgical excision

Lymph node dissection and radiation therapy can play adjunctive roles, depending on nature and extent of tumor

Adjunctive chemo and immuno used more now as well

Clinical staging best predictor (TNM system)

Overall 5 yr rate of cutaneous melanoma is 92%; 10 yr is 79% but wide variation depending on clincical status

Oral melanoma is poor; 5 yr surv rate of 13022%

Non-pigmented (amelanotic) lesions have esp poor prognosis

Oral melanoma pts usually die from distant metastasis rather than lack of local control