Papillary variant of squamous cell carcinoma arising on the gingiva: 61 cases reported from within a larger series of gingival squamous cell carcinoma.

Papillary squamous cell carcinoma (PSCCA) is a rarely occurring variant of squamous cell carcinoma (SCCA) with distinctive exophytic and papillary features and a more favorable prognosis than conventional SCCA. The larynx is the most commonly affected site in the head and neck. The oral cavity, oropharynx, sinonasal tract, and nasopharynx are also affected. Within the oral cavity cases have been reported on the alveolar ridge, oral mucosa, floor of the mouth, ventral tongue, and rarely other areas. We identified 61 cases of gingival PSCCA within the parameters of a larger study of 519 cases of gingival SCCA. We evaluated the clinical and histologic features of these lesions. The average age of the PSCCA patient was 74 years, with a very slight male predominance of 1.2:1. The mandible was affected nearly twice as often (64 %, n = 39) as the maxilla (35 %, n = 21, and 1 % of cases unspecified), and the most common location by far was the mandibular posterior region (52 %, n = 32). Most lesions were reportedly present over 2 months in duration (48 %, n = 29) prior to biopsy but a significant amount of clinicians were unsure of the duration of the lesion as well (36 %, n = 22). Only 10 cases (16 %) were reportedly present less than 2 months. The most common clinical presentation was that of an erythematous or mixed white and red exophytic mass (74 %, n = 45). 62 % (n = 38) of submitting clinicians considered a malignant or premalignant lesion in their differential diagnosis, but other clinical impressions included papillomas, reactive gingival lesions, and fungal infections. Histologically, 88 % (n = 52 of 59 cases graded) of the lesions were either well or moderately-well differentiated. PSCCA is a rare subtype of SCCA which has been reported infrequently involving the gingiva or alveolar ridges but should be considered by clinicians for the differential diagnosis of papillary gingival masses.

The clinical and histologic presentation of gingival squamous cell carcinoma: a study of 519 cases.

OBJECTIVES: Gingival squamous cell carcinoma (SCCA) often presents with benign features, which may lead to delay in treatment. This study describes the clinical and histologic characteristics of a series of gingival SCCA cases. STUDY DESIGN: A retrospective consecutive case review was performed using the University of Florida College of Dentistry Biopsy service's database, which yielded clinical and histologic information on 519 cases of gingival SCCA. RESULTS: The average age of affected patients was 72.3 years. The most common site was the mandibular posterior gingiva. Approximately 72% of lesions were present for >2 months at biopsy. The majority of clinicians considered a malignancy in their differential diagnosis (64%), although 15% considered only reactive lesions. Most of the carcinomas presented as exophytic masses and, histologically, were moderately differentiated. CONCLUSIONS: Gingival SCCA may present with varied clinical and histologic appearances and should be considered in the differential diagnosis of benign appearing lesions of the gingiva.