Skip to main content
Top
Published in: Oral Cancer 1-2/2018

01-06-2018 | Original Article

The oral pericommissural region: a distinct subsite—clinical features, histopathology, and treatment outcomes in 25 cases of squamous cancer

Authors: S. R. Priya, Chandrashekhar Dravid, R. K. Grover

Published in: Oral Cancer | Issue 1-2/2018

Login to get access

Abstract

Background

Oral squamous cancers constitute a large proportion of head–neck malignancies in India. One subset of oral cancers includes lesions arising in the oral commissure and the mucosa around it. These are unique in their location and pattern of spread with even small lesions affecting oral competence, function, and cosmesis. This study was done to analyse such “pericommissural” cancers and to explore if they should be placed in a distinct subcategory of buccal cancers with different implications for management and prognostication.

Method

25 cases of pericommissural squamous cancers were studied. Presentation, extent, differentiation, nodal metastases, and treatment outcomes were evaluated.

Results

Cancers of the pericommissure made up 8.7% of oral cancers that were treated surgically between 2013 and 2015. All cases underwent upfront surgery with neck dissection and reconstruction with local flaps. 36% cases were staged pT4; 12% cases had nodal involvement. 40% patients received adjuvant treatment. After a median follow-up of 676 days, there were no recurrences. Five patients died of unrelated causes and one patient died of a second primary in the lung. Functional and cosmetic outcomes were measured objectively as well as subjectively; patient expectations were taken into consideration and the scores were satisfactory.

Conclusion

Pericommissural squamous cancers show a distinct behaviour and it may be helpful to place these lesions in a separate subcategory of oral cancers. Functional and cosmetic aspects are as important in their management as is disease control.
Literature
2.
go back to reference Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E586CrossRefPubMed Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E586CrossRefPubMed
3.
go back to reference Roed-Petersen B, Gupta PC, Pindborg JJ, Singh B (1972) Association between oral leukoplakia and sex, age, and tobacco habits. Bull Org Hond Sant Bull Wid Hith Org J 47:13–19 Roed-Petersen B, Gupta PC, Pindborg JJ, Singh B (1972) Association between oral leukoplakia and sex, age, and tobacco habits. Bull Org Hond Sant Bull Wid Hith Org J 47:13–19
4.
go back to reference Vikneshan M, Ankola AV, Hiremath A, Hebbal M, Suganya M (2014) Smokeless tobacco and its adverse effects on oral cavity—an overview. Ann Dent Spec 2(2):64–69 Vikneshan M, Ankola AV, Hiremath A, Hebbal M, Suganya M (2014) Smokeless tobacco and its adverse effects on oral cavity—an overview. Ann Dent Spec 2(2):64–69
5.
go back to reference Balaram P, Sridhar H, Rajkumar T, Vaccarella S, Herrero R, Nandakumar A, Ravichandran K (2002) Oral cancer in Southern India: the influence of smoking, drinking, paan-chewing and oral hygiene. Int J Cancer 98:440–445CrossRefPubMed Balaram P, Sridhar H, Rajkumar T, Vaccarella S, Herrero R, Nandakumar A, Ravichandran K (2002) Oral cancer in Southern India: the influence of smoking, drinking, paan-chewing and oral hygiene. Int J Cancer 98:440–445CrossRefPubMed
6.
go back to reference Ogbureke KU, Bingham C (2012) Overview of oral cancer. In: Ogbureke KU (ed) Oral cancer. Intech, Croatia, pp 3–20CrossRef Ogbureke KU, Bingham C (2012) Overview of oral cancer. In: Ogbureke KU (ed) Oral cancer. Intech, Croatia, pp 3–20CrossRef
7.
go back to reference Madani AH, Jahromi AS, Dikshit M et al (2010) Risk assessment of tobacco types, oral cancer. Am J Pharmacol Toxicol 5:9–13CrossRef Madani AH, Jahromi AS, Dikshit M et al (2010) Risk assessment of tobacco types, oral cancer. Am J Pharmacol Toxicol 5:9–13CrossRef
8.
go back to reference Jayalekshmi PA, Gangadharan P, Akiba S, Koriyama C, Nair RR (2011) Oral cavity cancer risk in relation to tobacco chewing and bidi smoking among men in Karunagappally, Kerala, India: Karunagappally cohort study. Cancer Sci 102(2):460–467CrossRefPubMed Jayalekshmi PA, Gangadharan P, Akiba S, Koriyama C, Nair RR (2011) Oral cavity cancer risk in relation to tobacco chewing and bidi smoking among men in Karunagappally, Kerala, India: Karunagappally cohort study. Cancer Sci 102(2):460–467CrossRefPubMed
9.
go back to reference Herrero R, Castellsagué X, Pawlita M, Lissowska J, Kee F, Balaram P, Rajkumar T (2003) Human papillomavirus and oral cancer: the international agency for research on cancer multicenter study. J Natl Cancer Inst 95(23):1772–1783CrossRefPubMed Herrero R, Castellsagué X, Pawlita M, Lissowska J, Kee F, Balaram P, Rajkumar T (2003) Human papillomavirus and oral cancer: the international agency for research on cancer multicenter study. J Natl Cancer Inst 95(23):1772–1783CrossRefPubMed
10.
go back to reference Parkin DM, Louie KS, Clifford G (2008) Burden, trends of type specific human papillomavirus infections, related diseases in the Asia Pacific region. Vaccine 12:1–16 Parkin DM, Louie KS, Clifford G (2008) Burden, trends of type specific human papillomavirus infections, related diseases in the Asia Pacific region. Vaccine 12:1–16
11.
go back to reference De Stefani E, Boffetta P, Ronco AL, Correa P, Oreggia F, Deneo-Pellegrini H, Mendilaharsu M, Leiva J (2005) Dietary patterns and risk of cancer of the oral cavity and pharynx in Uruguay. Nutr Cancer 51:132–139CrossRefPubMed De Stefani E, Boffetta P, Ronco AL, Correa P, Oreggia F, Deneo-Pellegrini H, Mendilaharsu M, Leiva J (2005) Dietary patterns and risk of cancer of the oral cavity and pharynx in Uruguay. Nutr Cancer 51:132–139CrossRefPubMed
12.
go back to reference Pavia M, Pileggi C, Nobile CG, Angelillo IF (2006) Association between fruit and vegetable consumption and oral cancer: a meta-analysis of observational studies. Am J Clin Nutr 83:1126–1134CrossRefPubMed Pavia M, Pileggi C, Nobile CG, Angelillo IF (2006) Association between fruit and vegetable consumption and oral cancer: a meta-analysis of observational studies. Am J Clin Nutr 83:1126–1134CrossRefPubMed
14.
go back to reference Iamaroon A, Pattanaporn K, Pongsiriwet S, Wanachantararak S, Prapayasatok S, Jittidecharaks S, Chitapanarux I, Lorvidhaya V (2004) Analysis of 587 cases of oral squamous cell carcinoma in northern Thailand with a focus on young people. Int J Oral Maxillofac Surg 33(1):84–88CrossRefPubMed Iamaroon A, Pattanaporn K, Pongsiriwet S, Wanachantararak S, Prapayasatok S, Jittidecharaks S, Chitapanarux I, Lorvidhaya V (2004) Analysis of 587 cases of oral squamous cell carcinoma in northern Thailand with a focus on young people. Int J Oral Maxillofac Surg 33(1):84–88CrossRefPubMed
15.
go back to reference Iype EM, Pandey M, Mathew A, Thomas G, Sebastian P, Nair MK (2001) Oral cancer among patients under the age of 35 years. J Postgrad Med 47(3):171–176PubMed Iype EM, Pandey M, Mathew A, Thomas G, Sebastian P, Nair MK (2001) Oral cancer among patients under the age of 35 years. J Postgrad Med 47(3):171–176PubMed
16.
go back to reference Conway DI, Petticrew M, Marlborough H, Berthiller J, Hashibe M, Macpherson L (2008) Socioeconomic inequalities, oral cancer risk: a systematic review, meta-analysis of case-control studies. Int J Cancer 122:2811–2819CrossRefPubMed Conway DI, Petticrew M, Marlborough H, Berthiller J, Hashibe M, Macpherson L (2008) Socioeconomic inequalities, oral cancer risk: a systematic review, meta-analysis of case-control studies. Int J Cancer 122:2811–2819CrossRefPubMed
17.
go back to reference Dhar PK, Rao TR, Mohan S, Chandra S, Bhat KR, Rao K (2000) Identification of risk factors for specific subsites within the oral, oropharyngeal region—a study of 647 cancer patients. Indian J Cancer 37:114–122PubMed Dhar PK, Rao TR, Mohan S, Chandra S, Bhat KR, Rao K (2000) Identification of risk factors for specific subsites within the oral, oropharyngeal region—a study of 647 cancer patients. Indian J Cancer 37:114–122PubMed
18.
go back to reference Sitheeque MAM, Samaranayake LP (2003) Chronic hyperplastic candidosis/candidiasis (candidal leukoplakia). Crit Rev Oral Biol Med 14(4):253–267CrossRefPubMed Sitheeque MAM, Samaranayake LP (2003) Chronic hyperplastic candidosis/candidiasis (candidal leukoplakia). Crit Rev Oral Biol Med 14(4):253–267CrossRefPubMed
20.
go back to reference Gupta PC, Mehta FS, Daftary DK, Pindborg JJ, Bhonsle RB, Jalnawalla PN, Sinor PN, Pitkar VK, Murti PR, Irani RR, Shah HT (1980) Incidence rates of oral cancer and natural history of oral precancerous lesions in a 10-year follow-up study of Indian villagers. Commun Dent Oral Epidemiol 8(6):287–333CrossRef Gupta PC, Mehta FS, Daftary DK, Pindborg JJ, Bhonsle RB, Jalnawalla PN, Sinor PN, Pitkar VK, Murti PR, Irani RR, Shah HT (1980) Incidence rates of oral cancer and natural history of oral precancerous lesions in a 10-year follow-up study of Indian villagers. Commun Dent Oral Epidemiol 8(6):287–333CrossRef
21.
go back to reference Axell T (1987) Occurrence of leukoplakia and some other oral white lesions among 20333 adult Swedish people. Comm Dent Oral Epidemiol 15:46–51CrossRef Axell T (1987) Occurrence of leukoplakia and some other oral white lesions among 20333 adult Swedish people. Comm Dent Oral Epidemiol 15:46–51CrossRef
22.
go back to reference Lind PO (1987) Malignant transformation in oral leukoplakia. Scand J Dent Res 95:449–455PubMed Lind PO (1987) Malignant transformation in oral leukoplakia. Scand J Dent Res 95:449–455PubMed
23.
go back to reference Ikeda N, Ishii T, Iida S, Kawai T (1991) Epidemiological study of oral leukoplakia based on mass screening for oral mucosal diseases in a selected Japanese population. Community Dent Oral Epidemiol 19:160–163CrossRefPubMed Ikeda N, Ishii T, Iida S, Kawai T (1991) Epidemiological study of oral leukoplakia based on mass screening for oral mucosal diseases in a selected Japanese population. Community Dent Oral Epidemiol 19:160–163CrossRefPubMed
24.
go back to reference Mehta FS, Gupta PC, Pindborg JJ (1981) Chewing and smoking habits in relation to precancer and oral cancer. J Cancer Res Clin Oncol 99(1):35–39CrossRefPubMed Mehta FS, Gupta PC, Pindborg JJ (1981) Chewing and smoking habits in relation to precancer and oral cancer. J Cancer Res Clin Oncol 99(1):35–39CrossRefPubMed
25.
go back to reference Pindborg JJ, Kiaer J, Gupta PC, Chawla TN (1967) Studies in oral leukoplakias: prevalence of leukoplakia among 10 000 persons in Lucknow, India, with special reference to use of tobacco and betel nut. Bull World Health Organ 37(1):109PubMedPubMedCentral Pindborg JJ, Kiaer J, Gupta PC, Chawla TN (1967) Studies in oral leukoplakias: prevalence of leukoplakia among 10 000 persons in Lucknow, India, with special reference to use of tobacco and betel nut. Bull World Health Organ 37(1):109PubMedPubMedCentral
26.
go back to reference Mehta FS, Sanjana MK, Shroff BC, Doctor RH (1961) Incidence of leukoplakia among “Pan” (betel leaf) chewers and “bidi” smokers: a study of a sample survey. Indian J Med Res 49(3):393–399 Mehta FS, Sanjana MK, Shroff BC, Doctor RH (1961) Incidence of leukoplakia among “Pan” (betel leaf) chewers and “bidi” smokers: a study of a sample survey. Indian J Med Res 49(3):393–399
28.
go back to reference Silverman S, Gorsky M (1997) Proliferative verrucous leukoplakia: a follow-up study of 54 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84:154–157CrossRefPubMed Silverman S, Gorsky M (1997) Proliferative verrucous leukoplakia: a follow-up study of 54 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84:154–157CrossRefPubMed
29.
go back to reference Gupta PC, Murti PR, Bhonsle RB, Mehta FS, Pindborg JJ (1995) Effect of cessation of tobacco use on the incidence of oral mucosal lesions in a 10-year follow-up study of 12 212 users. Oral Dis 1(1):54–58CrossRefPubMed Gupta PC, Murti PR, Bhonsle RB, Mehta FS, Pindborg JJ (1995) Effect of cessation of tobacco use on the incidence of oral mucosal lesions in a 10-year follow-up study of 12 212 users. Oral Dis 1(1):54–58CrossRefPubMed
30.
go back to reference Martin GC, Brown JP, Eifler CW, Houston GD (1999) Oral leukoplakia status six weeks after cessation of smokeless tobacco use. J Am Dent Assoc 130(7):945–954CrossRefPubMed Martin GC, Brown JP, Eifler CW, Houston GD (1999) Oral leukoplakia status six weeks after cessation of smokeless tobacco use. J Am Dent Assoc 130(7):945–954CrossRefPubMed
31.
go back to reference Gupta PC, Bhonsle RB, Murti PR, Daftary DK, Mehta FS, Pindborg JJ (1989) An epidemiologic assessment of cancer risk in oral precancerous lesions in India with special reference to nodular leukoplakia. Cancer 63(11):2247–2252CrossRefPubMed Gupta PC, Bhonsle RB, Murti PR, Daftary DK, Mehta FS, Pindborg JJ (1989) An epidemiologic assessment of cancer risk in oral precancerous lesions in India with special reference to nodular leukoplakia. Cancer 63(11):2247–2252CrossRefPubMed
32.
go back to reference Silverman S Jr, Gorsky M, Lozada F (1984) Oral leukoplakia and malignant transformation: a follow-up study of 257 patients. Cancer 53:563–568CrossRefPubMed Silverman S Jr, Gorsky M, Lozada F (1984) Oral leukoplakia and malignant transformation: a follow-up study of 257 patients. Cancer 53:563–568CrossRefPubMed
33.
go back to reference Cowan CG, Gregg TA, Napier SS, Mckenna SM, Kee F (2001) Potentially malignant oral lesions in Northern Ireland: a 20-year population-based perspective of malignant transformation. Oral Dis 7:18–24PubMed Cowan CG, Gregg TA, Napier SS, Mckenna SM, Kee F (2001) Potentially malignant oral lesions in Northern Ireland: a 20-year population-based perspective of malignant transformation. Oral Dis 7:18–24PubMed
35.
go back to reference Reibel J (2003) Prognosis of oral pre-malignant lesions: significance of clinical, histopathological, and molecular biological characteristics. Crit Rev Oral Biol Med 14(1):47–62CrossRefPubMed Reibel J (2003) Prognosis of oral pre-malignant lesions: significance of clinical, histopathological, and molecular biological characteristics. Crit Rev Oral Biol Med 14(1):47–62CrossRefPubMed
36.
go back to reference Zawawi KH, Al-Badawi EA, Lobo SL, Melis M, Mehta NR (2003) An index for the measurement of normal maximum mouth opening. J Can Dent Assoc 69(11):737–741PubMed Zawawi KH, Al-Badawi EA, Lobo SL, Melis M, Mehta NR (2003) An index for the measurement of normal maximum mouth opening. J Can Dent Assoc 69(11):737–741PubMed
37.
go back to reference Khare N, Patil SB, Kale SM, Sumeet J, Sonali I, Sumeet B (2012) Normal mouth opening in an adult Indian population. J Maxillofac Oral Surg 11(3):309–313CrossRefPubMedPubMedCentral Khare N, Patil SB, Kale SM, Sumeet J, Sonali I, Sumeet B (2012) Normal mouth opening in an adult Indian population. J Maxillofac Oral Surg 11(3):309–313CrossRefPubMedPubMedCentral
38.
go back to reference Ranganathan K, Devi U, Elizabeth J, Arun B, Rooban T, Viswanathan R (2001) Mouth opening, cheek flexibility and tongue protrusion parameters of 800 normal patients in Chennai, South India. A base line study to enable assessment of alterations in oral submucous fibrosis. JIDA 72:78–80 Ranganathan K, Devi U, Elizabeth J, Arun B, Rooban T, Viswanathan R (2001) Mouth opening, cheek flexibility and tongue protrusion parameters of 800 normal patients in Chennai, South India. A base line study to enable assessment of alterations in oral submucous fibrosis. JIDA 72:78–80
39.
go back to reference Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, France Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, France
40.
go back to reference Percy C, Fritz A, Jack A, Shanmugarathan S, Sobin L, Parkin DM, Whelan S (2000) International classification of diseases for Oncology, 3rd edn. World Health Organization, Geneva Percy C, Fritz A, Jack A, Shanmugarathan S, Sobin L, Parkin DM, Whelan S (2000) International classification of diseases for Oncology, 3rd edn. World Health Organization, Geneva
41.
go back to reference Han M, Dillon J (2014) Lip cancer: general considerations. In: Lip cancer. Springer, Berlin, Heidelberg, pp 1–3 Han M, Dillon J (2014) Lip cancer: general considerations. In: Lip cancer. Springer, Berlin, Heidelberg, pp 1–3
43.
go back to reference Lin CS, Jen YM, Cheng MF, Lin YS, Su WF, Hwang JM (2006) Squamous cell carcinoma of the buccal mucosa: an aggressive cancer requiring multimodality treatment. Head Neck 28:150–157CrossRefPubMed Lin CS, Jen YM, Cheng MF, Lin YS, Su WF, Hwang JM (2006) Squamous cell carcinoma of the buccal mucosa: an aggressive cancer requiring multimodality treatment. Head Neck 28:150–157CrossRefPubMed
44.
go back to reference Deo SVS, Shukla NK, Jha D, Khanna P, Pandit A, Thulkari S (2012) Are we over-treating neck in buccal & alveolo-buccal cancers: experience from a tertiary cancer care center. Indian J Surg Oncol. 3(4):272–275CrossRefPubMedPubMedCentral Deo SVS, Shukla NK, Jha D, Khanna P, Pandit A, Thulkari S (2012) Are we over-treating neck in buccal & alveolo-buccal cancers: experience from a tertiary cancer care center. Indian J Surg Oncol. 3(4):272–275CrossRefPubMedPubMedCentral
45.
go back to reference Hiratsuka H, Miyakawa A, Nakamori K, Kido Y, Sunakawa H, Kohama G (1997) Multivariate analysis of occult lymph node metastasis as a prognostic indicator for patients with squamous cell carcinoma of the oral cavity. Cancer 80(3):351–356CrossRefPubMed Hiratsuka H, Miyakawa A, Nakamori K, Kido Y, Sunakawa H, Kohama G (1997) Multivariate analysis of occult lymph node metastasis as a prognostic indicator for patients with squamous cell carcinoma of the oral cavity. Cancer 80(3):351–356CrossRefPubMed
46.
go back to reference Vartanian JH, Carvalho AH, Filho MJA, Hattori M Jr, Kowalski JMLP (2004) Predictive factors and distribution of lymph node metastasis in lip cancer patients and their implications on the treatment of the neck. Oral Oncol 40(2):223–227CrossRefPubMed Vartanian JH, Carvalho AH, Filho MJA, Hattori M Jr, Kowalski JMLP (2004) Predictive factors and distribution of lymph node metastasis in lip cancer patients and their implications on the treatment of the neck. Oral Oncol 40(2):223–227CrossRefPubMed
47.
go back to reference Zitsch RP III, Park CW, Renner GJ, Rea JL Jr (1995) Outcome analysis for lip carcinoma. Otolaryngol Head Neck Surg 113(5):589–596CrossRefPubMed Zitsch RP III, Park CW, Renner GJ, Rea JL Jr (1995) Outcome analysis for lip carcinoma. Otolaryngol Head Neck Surg 113(5):589–596CrossRefPubMed
48.
go back to reference Coppit GL, Lin DT, Burkey BB (2004) Current concepts in lip reconstruction. Curr Opin Otolaryngol Head Neck Surg 12(4):281–287CrossRefPubMed Coppit GL, Lin DT, Burkey BB (2004) Current concepts in lip reconstruction. Curr Opin Otolaryngol Head Neck Surg 12(4):281–287CrossRefPubMed
Metadata
Title
The oral pericommissural region: a distinct subsite—clinical features, histopathology, and treatment outcomes in 25 cases of squamous cancer
Authors
S. R. Priya
Chandrashekhar Dravid
R. K. Grover
Publication date
01-06-2018
Publisher
Springer International Publishing
Published in
Oral Cancer / Issue 1-2/2018
Electronic ISSN: 2509-8837
DOI
https://doi.org/10.1007/s41548-018-0010-3

Other articles of this Issue 1-2/2018

Oral Cancer 1-2/2018 Go to the issue