The n e w e ng l a n d j o u r na l
Images in Clinical Medicine
Tanay V. Chaubal, M.D.S.
Padmashree Dr. D.Y. Patil University
Navi Mumbai, India
tanayvc@gmail.com
Renjeet A. Bapat, M.D.S.
International Medical University
Kuala Lumpur, Malaysia
1188
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Copyright 2017 Massachusetts Medical Society. All rights reserved.
of m e dic i n e
Chana A. Sacks, M.D., Editor
Squamous-Cell Carcinoma of the Mouth
A B
A
54-year-old woman presented to a dental clinic with a 1-year
history of oral swelling and a sore mouth. She had regularly chewed loose-
leaf tobacco, which she had placed on the floor of her mouth between the
jaw and tongue, up to five times each day for more than 10 years. Intraoral examina-
tion revealed an irregular, indurated lesion that measured 3 cm in its greatest
dimension and was located on the floor of the mouth inside the left jaw (Panel A).
Incisional biopsy of the lesion revealed invasive squamous-cell carcinoma with
hyperchromic, pleomorphic cells and a keratin pearl (Panel B, arrow) in the con-
nective tissue. Computed tomography and positron-emission tomography showed
no bony or lymph-node involvement. Squamous-cell carcinoma is the most com-
mon type of neoplasm of the oral cavity. The patient underwent an en bloc excision
of the carcinoma as well as segmental mandibulectomy with the use of a vascular-
ized free fibular flap as an osteocutaneous graft and selective neck dissection.
Pathological analysis revealed no involvement of bone or lymph nodes, with tumor-
free margins. The patient was advised to stop using tobacco products. Two years
after treatment, she remained free of recurrence.
DOI: 10.1056/NEJMicm1701886
Copyright 2017 Massachusetts Medical Society.
n engl j med 377;12 nejm.org September 21, 2017
The New England Journal of Medicine