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  • The demographics of oral cancer have changed, with more female, young, and nonsmoking patients presenting with carcinomas of the oral tongue.

  • The primary management for oral cancer remains surgery at present, though multidisciplinary management is essential, especially for advanced or recurrent disease. Improvements in reconstruction have improved quality of life in these patients.


  • Proper management of potentially malignant oral lesions may prevent the development of squamous cell carcinomas.

  • All patients should have a careful oral screening as this disease does not just occur in older adult male smokers.


  • Any lesion present in the mouth for more than 3 weeks that does not respond to medical treatment should be biopsied. Enlarged cervical nodes should not undergo an open biopsy.

  • The workup includes a clinical examination, endoscopy, and imaging. If no source is found, fine-needle aspiration is the investigation of choice or positron emission tomography.


  • Counselling regarding tobacco cessation and avoiding heavy use of alcohol is important. In Indian and South Asian patients, stopping the chewing of betel nut is important.

  • Patients who see a white patch in their mouth, even if it is painless, should consult their dentist or primary care provider.


This chapter will discuss current concepts in oral squamous cell carcinoma (OSCC) and mucosal melanoma of the oral cavity. The oral cavity is defined as those primary sites comprising the mucosal lips, buccal mucosa, lower alveolar ridge, upper alveolar ridge, retromolar fossa, floor of the mouth, hard palate, and the anterior two-thirds of the tongue.1 The chapter will describe recent changes in demographics, etiology, diagnosis, staging, and management of both squamous cell carcinoma and mucosal melanoma.


Demographics & Etiology

The estimated number of new oral cancer cases in the United States for 2019 was 35,130, of which almost 50% (17,060) were in the tongue. Males form 67.4% of the total number (23,690).2 Although oral cancer has traditionally been a disease of older men who smoke and consume alcohol,3,4 there has been a steady increase in the number of women diagnosed with oral cancer over the last 20 years.5 Continuing to smoke and intensity of smoking are also independent negative prognostic factors for overall survival in oral cancer.6 Interestingly, the increase in female cases of OSCC is not directly related to tobacco or alcohol use. Most female patients are never drinkers and never smokers (NSND). These patients without risk factors are disproportionately female or young (<40 years of age), and the site of predilection is the oral tongue. The etiology of these cancers is unknown at the current time, though many of these cancers are preceded by dysplastic leukoplakia.

The common genetic changes seen in adult smokers with OSCC, ...

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