Oral Squamous Cell Carcinoma (OSCC)
OSCC is the most common oral malignancy (>90% of oral cancers). Major risk factors: tobacco (smoked and smokeless), areca nut, alcohol (synergistic with tobacco), and HPV (notably oropharynx).
Sites & Presentation
Common sites include the lateral border of the tongue and floor of mouth. Presents as a non-healing ulcer with rolled/indurated margins, or an exophytic/verrucous mass.
Histopathology
Invasive islands and cords of malignant squamous epithelium with keratin pearls and individual cell keratinisation in well-differentiated tumours. Grading: well, moderately, poorly differentiated.
Verrucous Carcinoma (Ackerman tumour)
A low-grade variant with broad pushing (not infiltrating) margins; locally invasive but rarely metastasises → good prognosis.
Staging
TNM staging (tumour size, nodal involvement, metastasis) guides treatment and prognosis and is high-yield. Nodal metastasis markedly worsens prognosis.
Exam Tips ⭐
Keratin pearls = well-differentiated SCC. Verrucous carcinoma = pushing borders + good prognosis. Lateral tongue is a classic site.