Various treatment options of early carcinoma buccal mucosa involving commissure: a tertiary care centre experience of six years

Abstract

<p class="abstract"><strong>Background:</strong> Carcinoma of the buccal mucosa is the most common cancer of the oral cavity in India and involvement of commissure poses unique challenge in reconstruction after surgery. Aim was to analyse the demographics, presentations and various treatment options of early carcinoma buccal mucosa involving oral commissure.</p><p class="abstract"><strong>Methods:</strong> A retrospective review from clinical case records at our institution between 2014 and 2019 were analysed. All the cases recruited were analysed based on patient characteristics, clinical presentation, surgical and adjuvant therapy rendered. Statistical analysis was done using SPSS 20 software. </p><p class="abstract"><strong>Results:</strong> A total of 40 patients of primary carcinoma buccal mucosa with T1 to T3 disease involving commissure were analysed. Median age of presentation was 51 years with male preponderance (24:16). 32 patients were offered surgery as the initial line of management and 8 received definitive radiotherapy. The estimated 5-year survival was around 30%. Two patients with clinically T2 disease were upstaged in the postoperative histopathology to T3 and T4a respectively one due to depth of invasion >10 mm and the other owing to commissural skin involvement detected only in the final HPE.</p><p class="abstract"><strong>Conclusions:</strong> Early carcinoma of the buccal mucosa clinically extending from commissure poses unique challenges in choosing treatment modalities. In view of the location of the tumour it poses a small chance of upstaging of early disease in the final histopathology.</p>

Diagnostic Cytopathology of Human Buccal Mucosa Neoplasm

“…The lesion can progress and develop as an exophytic, irregular lobulated lesion or adopt an endophytic growth pattern characterized by a depressed ulcer with greyish-white edges, elevated, everted and indurate borders and an infiltrated base. In most cases, lesions are asymptomatic; pain appears only when muscles or nerves are invaded at advanced stages of the disease (Silverman et al, 1998;Neville, Day, 2002). Generally, OSCC arises from within a field of pre-cancerized epithelium either from a pre-existing potentially malignant lesion, or de novo.…”

“…Therefore, more aggressive post-operative therapy is suggested for patients with buccal mucosa carcinoma excised with a close margin of ≤3 mm (Chiou et al, 2010). Commissural skin involvement and in situ invasion in buccal mucosa carcinoma poses unique challenges in choosing treatment modalities (Shanmugam et al, 2020).…”