Oral Cancers

Kevin Berman, MD, PhD Health Guide
  • Hi, everyone. I hope you all had a good Thanksgiving full of healthy amounts of good food.

    I want to talk about cancers of the lips, tongue, and other areas of the oral cavity as these often present to the dermatologist after patients notice that something doesn't feel right inside the mouth while eating.

    Cancer on the lips is often related to sun exposure, while cancers occurring inside the mouth are often related to tobacco, alcohol, or poor oral hygiene.

    It is important to catch cancer early when it is still localized on the oral mucous membranes, because cancers of the mouth are at high risk of metastasizing to the lymph nodes of the neck. Squamous cell carcinoma is the type of cancer that most commonly arises in the mouth, so now we will talk about some of the lesions that occur in the mouth that can lead to squamous cell carcinoma.
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    The term "actinic cheilitis" refers to an inflammatory reaction of the lips to chronic sun exposure. In this condition, the lower lip is usually scaly or has fissures and may be considered as a "precancerous" state as squamous cell carcinoma can arise in these areas.

    Much like "actinic keratoses" are considered precancers of the skin, actinic cheilitis is considered precancerous lesions of the lips. Because of the relationship to sunlight, using a lip balm with sun protection is important and should be used on a daily basis.

    Treatment Options: From Ointments to Surgery

    Treatment of actinic cheilitis is similar to the treatment of actinic keratoses, and include freezing with liquid nitrogen to destroy the abnormal cells on the surface. Topical therapy for skin cancer with either fluorouracil or imiquimod can also be used (these are the same topical creams used for precancers on the skin). If the lesions do not improve with these therapies, other surgical options, including excising the affected area or treating with laser surgery are other options to discuss with your doctor.

    "Leukoplakia" is the term used to describe white thickening of the oral mucous membranes and also can serve as a precursor to squamous cell carcinoma. It is usually caused by sun exposure or pipe smoking. The lips, gums, cheeks, and sides of the tongue are the most common sites where this white thickening occurs.

    The white areas that do not rub off need to be biopsied in order to make sure there is no squamous cell carcinoma. Some people first notice these lesions if they bleed without any inciting trauma. Surgery for these areas is usually the best treatment in order to ensure complete removal.

    While leukoplakia is white, "erythroplakia" refers to red areas in the mouth that are otherwise very similar to leukoplakia. These red areas are often related to an underlying squamous cell carcinoma.

    While squamous cell carcinoma is the most common cancer of the oral cavity, melanoma can occur in the mouth and carries a worse prognosis because it is usually very deep by the time it is discovered; and deep melanomas are more likely to metastasize. Most pigmented lesions found on the lips and gums are benign lesions, such as freckles or moles. There are several inherited conditions in which many moles appear on the lips, and these are all non-cancerous. However, the same rules for melanoma on the skin apply to the lips and oral mucous membranes. Any irregularly shaped or changing pigmented lesion on the lips or in the mouth should be biopsied to rule out melanoma. Treatment for melanoma in these locations is with surgery.

  • I hope this sheds some light on looking for skin cancers in an area most would not consider looking for cancer. Although smoking and chewing tobacco are two of the biggest risk factors, we are all at risk so it is important to allow your health care provider to look inside your mouth for suspicious lesions.
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Published On: December 07, 2006