What is a Epidermoid
Carcinoma?
Epidermoid, or squamous, carcinoma is often characterized
by rapidgrowing lesions that vary tremendously in appearance;
they can be red or white, smooth or rough, ulcerated or
not ulcerated, and elevated or depressed. The ulcerated
lesions extend beneath the
surface of the skin (mucosa) with crab-like extensions
that invade the adjoining tissues and structures.
The lesions associated with squamous carcinoma
are found more frequently in men over 40 years of age,
but in recent years have shown a trend to affect younger
people and more females; it is believed that this is related
to the increased use of tobacco among these groups. Squamous
carcinoma can be found at any oral site, but is most common
on the lips, the tongue, the floor of the mouth, or the
inside of the cheeks. Left untreated, it can spread to
other parts of the body, so it's vital that we diagnose
and treat these lesions early, as this form of cancer
can be fatal.
Leukoplakia, white patchy lesions that cannot
be rubbed off, and swollen lymph nodes near the affected
area often accompany squamous carcinoma lesions. The lesions
are usually not painful unless they are infected or intrude
on the adjacent nerves.
Squamous carcinoma is the second most common
form of skin cancer among Caucasians; it occurs very rarely
in dark-skinned individuals. The oral form of the disease
is almost always associated with smoking and alcohol use,
but exposure to sun and radiation can also increase the
incidence of this potentially deadly disease on the skin
and lips. Poor oral hygiene, repeated trauma or irritation
to the area, local infections such as herpes and candidiasis,
environmental toxins, malnutrition and systemic disease
like syphilis and cirrhosis have also all been shown to
be possible factors in squamous carcinoma.
Treatment Options
If a biopsy indicates that the lesion is indeed squamous
carcinoma, your treatment will center around surgical
removal of the lesion.
Radiation treatment may also be recommended. However,
treatment must be customized according to the location,
extent and nature of the tumor, and may also include one
or more of the following:
• Super-voltage radiation
• Chemotherapy
• Immunotherapy
What is Epithelial Dysplasia?
Epithelial dysplasia refers to microscopic changes in
the cells that make up the outer layer of the mouth's
lining (the mucosa), similar to changes usually seen in
cancers in the same location. The changes associated with
epithelial dysplasia can occur at any site in the mouth,
but are most common on the tongue, lips, and the floor
of the mouth. Men between the ages of 50-70 are most susceptible
to these lesions, particularly if they have a history
of tobacco or alcohol use, or if other oral cancer risk
factors are present. Epithelial dysplasias are classified
as mild, moderate and severe, depending on the extent
and severity of the cellular changes. Epithelial dysplasia
is usually associated with a color change in the affected
tissue, usually to red and/or white. The lesions associated
with this condition tend to be white plaques, either rough
or smooth, or velvety red spots or plaques. They may produce
a burning sensation, or no symptoms at all, and can thicken,
harden or expand. The condition's cause is unknown, but
it can transform into invasive carcinoma (cancer), so
it should not be ignored.
Treatment Options
Because there is a chance these lesions can become cancerous,
it is important that we remove them as soon as possible.
• We can remove small lesions (under two centimeters)
surgically in their entirety. It is of utmost importance
that we submit this tissue for microscopic diagnosis,
preferably to an oral and maxillofacial pathologist.
• If the lesions are very large, it is often wise
to take a sample (biopsy) of tissue for microscopic diagnosis.
If there is no significant dysplasia, we will remove the
remainder of the lesion using cauterization, cryosurgery
(freezing), or with a laser.
• We will follow these lesions on a routine basis
to check for recurrence or for developing new lesions.
What is Epithelial Hyperplasia?
Epithelial hyperplasia is a thickening of the outer layer
of the mucosa(the lining of the inside of the mouth) and
the skin. This outer layeris called the epithelium. The
degree of thickening can vary greatly. Sometimes it may
even go unnoticed. In this case, we would discover the condition
only when we examine the tissue under a microscope after
having removed it surgically for other reasons. However,
epithelial hyperplasia can also cause enough thickening
in the mouth's lining to make it obvious when we visually
examine the area. There are many causes for epithelial hyperplasia.
Irritation of the epithelium is the most common cause. Some
irritating factor include habitual lip and cheek biting,
holding objects such as toothpicks, pencils, or tobacco
pipes in the mouth, wearing dental appliances such as orthodontic
bands and wires, restorations with rough edges, and wearing
full and partial dentures. Also, many conditions that cause
swelling in the mouth, such as gum disease, traumatic ulcers,
and canker sores, for example, also have areas of epithelial
hyperplasia associated with them. Sometimes there is no
obvious cause.
Treatment Options
Generally, epithelial hyperplasia has no dysplasia
(abnormal cell changes associated with cancerous lesions)
associated with it. Because of this, the condition requires
only minor treatment.
• We will first determine the source of the irritation
that caused the tissue thickening to develop.
• We will modify the irritating factor, either
by removing or fixing an irritating restoration, appliance,
or denture, or by calling any irritating habits to the
patient’s attention. This may be adequate treatment
to bring about reversal of the hyperplasia..
• If the hyperplasia persists, we may perform surgery
to remove the thickening if it causes discomfort or
is frequently ulcerated.
What is Fibroepithelial Polyp?
Fibroepithelial polyps are small, round, knob-like growths
that can form anywhere on the mucosa (the pink tissue lining
the inside of themouth), but are most common on the tongue
and the lips. They are frequently caused by minor irritation
or trauma, such as accidentally biting the area, and are
made up of a thin layer of normal epithelium (the outer
layer of mucosa or skin) surrounding a fibrous tissue core.
Fibroepithelial polyps are most commonly single lesions,
but occasionally occur as multiple lesions. Fibroepithelial
polyps are painless, but are subject to recurrent trauma,
so infection is possible. They are usually pink in color,
unless they have become irritated or infected; in this case,
they may be red, white, or red and white. They are similar
in appearance to fibromas and papillomas. However, both
of these conditions typically grow steadily and can reach
several centimeters in diameter; fibroepithelial polyps
rarely continue to grow and usually remain as small, finger-like
projections, seldom exceeding a few millimeters in diameter.
They can only be diagnosed by examining their cells under
a microscope after the lesion has been surgically removed.
Treatment Options
We will remove the polyp surgically, and will also remove
any source
of irritation so the lesion does not occur again.
What is A Fibroma?
Most fibromas of the oral cavity are caused by long-term
irritation or trauma, such as persistent cheek or lip biting.
They consist of
increased numbers of normal cells (called hyperplasia) that
are fibrous in nature. They can be found anywhere in the
mouth, but the
most common areas for fibromas to develop are the insides
of the cheeks, the corners of the mouth, and the tongue.
Fibromas are most commonly attached to the mouth by either
by a wide base of tissue or a stalk-like growth of tissue.
They range in size from a few millimeters to several centimeters
in diameter. The surface texture is usually smooth, like
normal mouth tissue, and may be
either very soft or firm to the touch. Fibromas are the
most common tumor-like lesions in the mouth. They can form
at any age, but are most commonly seen in the 30 to 50 age
group. They usually develop slowly, and though they're typically
not painful, they can be easily traumatized; this can result
in an ulceration. If a fibroma is not removed, it can become
quite large, making it even more susceptible to irritation
and ulceration.
Treatment Options
The usual treatment is simple surgical removal and elimination.
Healing in the mouth is normally fairly rapid.
