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Screening for and diagnosis of oral premalignant lesions and oropharyngeal squamous cell carcinoma

Role of primary care physicians

Meir Gorsky, DMD
Professor in the Department of Oral Medicine at Tel Aviv University in Israel and a Visiting Professor at the College of Dentistry at the University of Illinois

Robert J. Cabay, MD DDS
Resident in the Department of Pathology of the College of Medicine at the University of Illinois

Terry Day, MD
Associate Professor and Director of the Division of Head and Neck Oncologic Surgery in the Department of Otolaryngology-Head and Neck Surgery at the Medical University of South Carolina in Charleston

Wanda Gonsalves, MD
Assistant Professor in the Department of Family Medicine at the Medical University of South Carolina

Correspondence to: Dr J. Epstein, Department of Oral Medicine and Diagnostic Sciences (MC838), University of Illinois at Chicago, 801 S Paulina St, Room 56x, Chicago, IL 60612, USA; telephone 312 996-7480; fax 312 355-2688; e-mailjepstein{at}uic.edu

OBJECTIVE To describe the role that primary care physicians can play in early recognition of oral and oropharyngeal squamous cell carcinomas (OOSCCs) and to review the risk factors for OOSCCs, the nature of oral premalignant lesions, and the technique and aids for clinical examination.

QUALITY OF EVIDENCE MEDLINE and CANCERLIT literature searches were conducted using the following terms: oral cancer and risk factors, pre-malignant oral lesions, clinical evaluation of abnormal oral lesions, and cancer screening. Additional articles were identified from key references within articles. The articles contained level I, II, and III evidence and included controlled trials and systematic reviews.

MAIN MESSAGE Most OOSCCs are in advanced stages at diagnosis, and treatment does not improve survival rates. Early recognition and diagnosis of OOSCCs might improve patient survival and reduce treatment-related morbidity. Comprehensive head and neck examinations should be part of all medical and dental examinations. The head and neck should be inspected and palpated to evaluate for OOSCCs, particularly in high-risk patients and when symptoms are identified. A neck mass or mouth lesion combined with regional pain might suggest a malignant or premalignant process.

CONCLUSION Primary care physicians are well suited to providing head and neck examinations, and to screening for the presence of suspicious oral lesions. Referral for biopsy might be indicated, depending on the experience of examining physicians.