Oral Cancer
Oral Squamous Cell Carcinoma
aka Oral SCC · OSCC
Malignant epithelial neoplasm; > 90% of all oral malignancies. Sixth most common cancer worldwide.
§ figuresFigures (2)
Fig. 1Oral pseudomembranous candidiasis on the dorsum of the tongue
“Oral pseudomembranous candidiasis on the dorsum of the tongue of a 59-year-old male (third week of RT for a squamous cell carcinoma of the floor of the mouth, T3N0M0, daily dose 1.8 Gy)” · Ourania Nicolatou-Galitis et al. · CC0 · Wikimedia Commons
Fig. 2A large squamous cell carcinoma of the tongue
“SquamousCellCarcinomaTongueCT” · James Heilman, MD · CC BY-SA 4.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Oral Squamous Cell Carcinoma figures pending faculty review.
§ overviewOverview
Malignant epithelial neoplasm; > 90% of all oral malignancies. Sixth most common cancer worldwide.
§ etiologyEtiology
- 01Tobacco (smoked & smokeless)
- 02Alcohol (synergistic with tobacco)
- 03Areca nut
- 04HPV 16 (oropharyngeal)
- 05Chronic trauma
- 06Immunosuppression
§ epidemiologyEpidemiology
M > F, > 50 years. South Asia highest incidence globally.
§ clinicalClinical Features
- 01Non-healing ulcer > 3 weeks
- 02Indurated margins, everted edges
- 03Fixed to underlying tissues
- 04Cervical lymphadenopathy
- 05Common sites: lateral tongue, floor of mouth, gingiva
§ differentialDifferential Diagnosis
- 01Traumatic ulcer
- 02Tuberculous ulcer
- 03Syphilitic gumma
- 04Deep fungal infection
§ histopathHistopathology
- 01Invasive nests and cords of atypical squamous epithelium
- 02Keratin pearls (well-differentiated)
- 03Nuclear pleomorphism, mitotic figures
- 04Broders' grading I–IV
§ investigationsInvestigations
- 01Incisional biopsy — gold standard
- 02CECT / MRI — local extent
- 03USG neck + FNAC — nodal disease
- 04PET-CT — distant metastasis / recurrence
- 05Chest imaging
§ stagingStaging
AJCC 8th ed TNM — DOI (depth of invasion) and ENE (extra-nodal extension) incorporated.
§ treatmentTreatment
- 01Stage I–II: single-modality — surgery OR radiotherapy
- 02Stage III–IV: composite resection + neck dissection + adjuvant CRT
- 03Neck: elective SND for cN0 with DOI > 3 mm
- 04Targeted / immunotherapy: cetuximab, pembrolizumab, nivolumab for recurrent/metastatic
§ complicationsComplications
- 01Loco-regional recurrence
- 02Distant metastasis (lung most common)
- 03Second primary (field cancerisation)
§ prognosisPrognosis
5-year survival: Stage I 80%, Stage IV < 30%.
§ preventionPrevention
- 01Tobacco/alcohol cessation
- 02HPV vaccination
- 03Regular oral screening
§ vivaBDS Viva Questions
- 01Define depth of invasion and its prognostic significance.
- 02Indications for elective neck dissection in cN0 OSCC.
§ pearlsClinical Pearls
- 01Any oral ulcer that fails to heal within 3 weeks must be biopsied.
§ mnemonicsMnemonics
- 01FEAR — Fixed, Everted, Anaesthetic, Rolled edges
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Head and Neck Tumours
5th Edition — Volume 9
WHO Classification of Tumours Editorial Board · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 2
- L3 · Systematic review — 2
- L4 · Research — 2
- L6 · Textbook — 3
2 linked sources were published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
WHO Classification of Tumours Editorial Board. IARC / World Health Organization · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Systematic Reviews & Meta-Analyses
de Almeida-Silva LA, Lupp JDS, Sobral-Silva LA et al.. Oral surgery, oral medicine, oral pathology and oral radiology · 2024 · 138(1):66-78
Systematic review of osteoradionecrosis incidence after intensity-modulated radiotherapy for oral cavity cancer.
Walsh T, Liu JL, Brocklehurst P et al.. The Cochrane database of systematic reviews · 2013 · 2013(11):CD010173
Cochrane review of conventional oral examination and adjuncts for detecting oral cancer and potentially malignant disorders.
Key Research
D'Cruz AK, Vaish R, Kapre N et al.. The New England journal of medicine · 2015 · 373(6):521-9
Randomised trial showing survival benefit of elective neck dissection over therapeutic dissection in node-negative oral cancer.
Ang KK, Harris J, Wheeler R et al.. The New England journal of medicine · 2010 · 363(1):24-35
RTOG 0129 analysis establishing HPV status as an independent prognostic factor in oropharyngeal carcinoma.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.