Management of chronic traumatic ulcer mimicking oral squamous cell carcinoma on the tongue

Abstract

Background: Traumatic ulcers represent the most common oral mucosal lesions that can be differentiated from oral squamous cell carcinoma (OSCC) by their clinical appearance. From a clinical perspective, OSCC may resemble a chronic traumatic ulcer (CTU) because the base of the CTU that is healing is filled with reddish-pink granulated tissue, similar to that in OSCC. Purpose: The aim of this case report is to provide information about the oral management of a CTU case that imitates OSCC. Case: A 30-year old female presented with a major, painful, non-healing ulcer located on the right lateral of the tongue for the previous two months. Approximately two years before, she had experienced a similar lesion on the tongue. Intra oral examination showed a 10mm x 5mm yellowish ulcer with a fibrous center, erythematous irregular-induration margin and concave yellow base. The 15th, 44th and 47th teeth were sharp and on occlusion caused trauma to the right lateral border of the tongue. Case management: Based on the clinical features, the lesion was imitating OSCC. After a case history review, clinical examination and appropriate investigation, the patient was diagnosed as suffering from a chronic traumatic ulcer. The primary treatment of traumatic ulcers involves eliminating etiological factors. As pharmacological therapy, a mixture of triamcinolone acetonide and 1mg dexamethasone tablet was administered in addition to folic acid and vitamin B12. Conclusion: Clinical presentation of traumatic lesions varies significantly and may, at times, be ambigous. It is important to immediately establish a correct diagnosis and implement prompt treatment of CTU lesions because they play a role at the oral carcinogenesis promotion stage.

Role of Topical Anesthetics Versus Topical Steroids in The Management of Traumatic Ulcer: A Case Control Study

“…Another study also found that topical anesthetics were the predominant drug of choice in the management of traumatic ulcer (Choudhury, 2015;Nelonda and Setiadhi, 2018).…”

Non-smoker and Non-Drinker Farmer with Oral Squamous Cell Carcinoma

“…The clinical manifestations after 5 weeks was ulcer, 2x2 cm in size, with indurated edges, with necrotic tissue in the middle with hard palpations giving a strong suspicion that the lesion was OSCC. 4 As a dentist it was necessary to ascertain the ulcer lesions resembling a malignancy and to consider the patient's work to be able to predict a diagnosis of the lesion. The ulcer was treated with 0.2% chlorehexidine digluconate as an antiseptic with a longlasting antibacterial activity and with broad-spectrum bactericidal that can reduce plaque, inflammation and bleeding.…”

An erosive lesion of the buccal mucosa revealing an early squamous cell carcinoma

“…[2,3] An OSCC is the most common persistent ulcer affecting the oral cavity which encompasses 90-95% of oral cancers. [4]It generally affects men aged over 50, most of them with a history or risk factors of high tobacco smoking, alcohol consumption, and smokeless tobacco use… [2,5] OSCC has various clinical presentations and may, at times, be ambiguous. Early lesions are often asymptomatic and can often be misdiagnosed as other inflammatory lesions in the oral cavity, a fact that can cause the patient to delay seeking treatment.…”

“…Early lesions are often asymptomatic and can often be misdiagnosed as other inflammatory lesions in the oral cavity, a fact that can cause the patient to delay seeking treatment. [4] An early OSCC may be a shallow ulcer with a velvety red base and a firm, raised border. A healing chronic traumatic ulcer can resemble an early OSCC because its base may be filled with reddish-pink granulation tissue.…”