Oral cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another.

Oral cancer must be differentiated from actinic keratosis, dermatologic manifestations of oral leukoplakia, erythroplasia, lichen planus and mucosal candidiasis.

Oral cancer differential diagnosis

Type of cancer	Subtype	ICD-O Code	Epidemiology	Etiology	Second primary tumors	Localization	Clinical features	Diagnostic procedures
Squamous cell carcinoma	Verrucous carcinoma	8051/3	Older males	Chronic smokeless tobacco HPV 16 and 18
	Basaloid squamous cell carcinoma	8083/3
	Papillary squamous cell carcinoma	8052/3
	Spindle cell carcinoma	8074/3
	Acantholytic squamous cell carcinoma	8075/3
	Adenosquamous carcinoma	8560/3
	Carcinoma cuniculatum (epithelioma cuniculatum)	8051/3
Lymphoepithelial carcinoma
Epithelial precursor lesions
Proliferative verrucous leukoplakia and precancerous conditions
Papillomas	Squamous cell papilloma and verruca vulgaris
	Condyloma acuminatum
	Papillomas and papillomatosis in immunodeficiency
	Focal epithelial hyperplasia
Granular cell tumour
Keratoacanthoma
Papillary hyperplasia
Median rhomboid glossitis
Median rhomboid glossitis
Salivary gland tumours	Acinic cell carcinoma	8550/3
	Mucoepidermoid carcinoma	8430/3
	Adenoid cystic carcinoma	8200/3
	Polymorphous low-grade adenocarcinoma	8525/3
	Epithelial-myoepithelial carcinoma	8562/3
	Clear cell carcinoma, NOS	8310/3
	Basal cell adenocarcinoma	8147/3
	Cystadenocarcinoma	8450/3
	Mucinous adenocarcinoma	8480/3
	Oncocytic carcinoma	8290/3
	Salivary duct carcinoma	8500/3
	Myoepithelial carcinoma	8982/3
	Carcinoma ex pleomorphic adenoma	8941/3
Salivary gland adenomas	Pleomorphic adenoma	8940/0
	Myoepithelioma	8982/0
	Basal cell adenoma	8147/0
	Canalicular adenoma	8149/0
	Duct papilloma	8503/0
	Cystadenoma	8440/0
Kaposi sarcoma
Lymphangioma
Ectomesenchymal chondromyxoid tumour of the anterior tongue
Focal oral mucinosis
Congenital granular cell epulis
Haematolymphoid tumours	Non-Hodgkin lymphoma		Second most com- mon cancer of the oral cavity.	There is no known etiology in most patients. Underlying immunodeficiency state (e.g. HIV Infection) Strong association with EBV		Palate, Tongue Floor of mouth Gingiva Buccal mucosa Lips Palatine tonsils Lingual tonsils or Oropharynx	NHL of the lip presents with: Ulcer Swelling, Discoloration Pain Paraesthesia Anaesthesia, or Loose teeth	Biopsy shows: Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology. Predominantly medium-sized cells with abundant pale cytoplasm. Large cells with round or multilobated nuclei
	Extramedullary plasmacytoma	9734/3
	Langerhans cell histiocytosis	9751/1		Associated with: Eosinophilic granulomas Multifocal multisystem disease		Jaw bone Intraoral soft tissues Gingiva Palate Floor of mouth Buccal mucosa and Tonsil	Common oral symptoms include: Swelling Pain Gingivitis Loose teeth and Ulceration	Biopsy shows ovoid Langerhans cells with deeply grooved nuclei, thin nuclear membranes and abundant eosinophilic cytoplasm
	Hodgkin lymphoma			Strongly associated with Epstein- Barr Virus		Waldeyer ring, particularly the pala-tine tonsil Oropharynx Alveolar crest of mandible Maxillary gingiva	Most patients present with localized disease (stage I/II), with Chronic tonsillitis or tonsillar enlargement with or without enlarged cervical lymph nodes
	Extramedullary myeloid sarcoma	9930/3		History of acute myeloid leukaemia, predominantly in the monocytic or myelomonocytic subtypes		Palate Gingiva	Isolated tumor-forming intraoral mass	Biopsy shows an Indian-file pattern of infiltration
	Follicular dendritic cell sarcoma / tumour	9758/3	Tumor of adulthood Affects wide age range	History of underlying hya-line-vascular Castleman disease		Tonsil Palate or Oropharynx.	The patients usually present with a painless mass	Biopsy usually exhibits borders and comprises: Fascicles Whorls Nodules, Storiform arrays or Diffuse sheets of spindly to ovoid tumour cells sprinkled with small lymphocytes
Mucosal malignant melanoma		8720/3	0.5% of oral malignancies Incidence 0.02 per 100,000	No known etiological factors associated with oral melanoma		80% arise: Palate Maxillary alveolus or gingivae Mandibular gingivae Others: Buccal mucosa Floor of mouth Tongue	Asymmetric with irregular outlines Macular pigmentation Nodular growth Ulceration Melanosis	Biopsy: S100 positive Negative for cytokeratins More specific markers include: HMB45, Melan-A or anti-tyrosinase

References

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