Arthur Mashberg

Anatomical site and size of 222 early asymptomatic oral squamous cell carcinomas. A continuing prospective study of oral cancer. II

The site and size of 222 asymptomatic, primarily erythroplastic, cancers of the oral mucosa in 161 patients have been prospectively documented. Of 207 intraoral lesions (excluding 15 of the lip), 201 (97.1%) were found in three locations; floor of the mouth (101), ventral or lateral tongue (36), and soft palate complex (64). Of the 101 in the floor of the mouth, 73 occurred in the anterior portion with 33 involving the papilla at exit of Whartons Duct (submaxillary gland). Of the cancers 84.2% were 2 cm or less and 41.9% were 1 cm or less. Of the lesions 2 cm or less 70.6% were invasive carcinoma. Minimal size does not preclude invasiveness. In view of the apparent predilection of oral carcinoma for particular sites (where there is no obvious agent), rather than random occurrence, the three aforementioned sites are designated as high risk areas which deserve particular scrutiny in an examination of the oral cavity. It is incumbent upon the clinician to biopsy all asymptomatic, persistent (14 days or more) mucosal aberrations in the high risk areas, especially those with erythroplastic components, regardless of size.

Reevaluation of toluidine blue application as a diagnostic adjunct in the detection of asymptomatic oral squamous carcinoma: a continuing prospective study of oral cancer III.

This study was initiated to evaluate toluidine blue application as a worthwhile and simple diagnostic adjunct to clinical impressions. In an attempt to decrease false positives, a 10–14 day waiting period was initiated to allow inflammatory lesions to resolve before application of stain. Using toluidine blue applications with 235 prospectively documented persistent lesions (105 carcinomas and 130 non‐malignant lesions) resulted in a false negative rate (underdiagnosis) of 6.7% and false positive rate (overdiagnosis) of 8.5%. Using clinical criteria alone resulted in a false negative rate of 4.8% but with a tendency to overdiagnose—28.5% false positives. Combining both diagnostic modalities reduced the false negative rate to 1.9%, i.e., only two of the 105 cancers were not considered significant by toluidine blue stain or clinical impression. This staining technique appears to offer a feasible diagnostic “control” over the subjective impression of the clinician. Persistent lesions that stain with toluidine blue should be considered carcinoma unless proven otherwise by biopsy.

Olfactory neuroblastoma (esthesioneuroepithelioma) of the maxillary sinus.

Abstract 1. 1. A case of olfactory neuroblastoma (esthesioneuroepithelioma) has been presented. 2. 2. This tumor is quite rare; only twenty-seven cases have been reported in the world literature. It is usually located in the nasal fossa. 3. 3. In the case presented here the neoplasm was confined to the left antrum, which is an unusual location. 4. 4. From its radiographic appearance, it was thought to be an osteochondroma. 5. 5. Symptoms are not specific, and therefore diagnosis is difficult. Proper diagnosis can be made solely by biopsy with special and meticulous histologic techniques. 6. 6. Although these tumors are not metastatic, they are believed to be invasive in character. 7. 7. They are amenable to treatment by surgical removal or, if there are recurrences, by surgery in conjunction with follow-up x-ray therapy.

Early Oral and Oropharyngeal Cancer Diagnosis and Management

Sixteen thousand new cases of intraoral squarnous cell carcinoma, excluding lip, were reported in the United States in 1986 (1). Pharyngeal cancers accounted for an additional 8,900 cases. Other aerodigestive cancers (e.g., larynx, esophagus, and lung), which probably share a common etiology with oral and pharyngeal cancer and frequently coexist as second primaries, increased the number by 174,000 cases.

Lipoma of the tongue; report of a case.

Abstract A case of lipoma of the tongue is presented. The occurrence of a lipoma in this structure is rare.