History
When questioned about the area, the patient claimed the ulcer had been present for at least six months, maybe longer. No pain or discomfort was noted by the patient. When questioned about excessive sun exposure, the patient stated that he spends many hours outdoors and does not use sunblock. The patient denied a history of smoking and alcohol use. No history of trauma to the area was noted.
The patient had a previous history of regular and routine dental care. At the time of the dental appointment, the patient was not taking medications of any kind. No significant problems were noted during the health history.
Examinations
Physical examination of the head and neck region revealed no abnormal findings. The patient`s vital signs were all found to be within normal limits. No palpable lymph nodes were detected. No other abnormal extraoral findings were noted. Oral examination revealed an ulcerative lesion of the vermilion of the lower lip, measuring one centimeter in diameter (see photo). When palpated, the periphery of the lesion felt indurated.
Clinical diagnosis
Based on the clinical information presented, which one of the following is the most likely diagnosis?
* erosive lichen planus
* actinic cheilitis
* squamous cell carcinoma
* traumatic ulcer
* recurrent herpes labialis
Diagnosis
squamous cell carcinoma
Discussion
Squamous cell carcinoma (SCC) is derived from the squamous epithelial cells, which are the flat and scaly cells found on the surface of the oral mucosa. When these squamous cells become cancerous, the cancer is referred to as a carcinoma, which is defined as a malignancy of epithelial origin. SCC is found both on the lips and inside the oral cavity. An estimated 90-95 percent of all oral cancers are squamous cell carcinoma. SCC behaves differently depending upon its location; therefore, a separate discussion of SCC of the lip and intraoral SCC is warranted.
The major causative factor for SCC of the lip is prolonged sun exposure. In addition, certain forms of tobacco use play a contributing role – pipe and cigar smoking are often linked to SCC of the lip.
Clinical features
Although SCC of the lip may occur at any age, this lesion most often occurs in adults between the ages of 50 and 70; men are twice as likely to be affected as women. The lower lip is affected by SCC far more frequently than the upper lip.