Forum for Clinical and Surgical Oral Pathology

Case BBOPF 06-4 PART II. "The Answer"

Dr. John Lovas provides in the following paragraphs the conclusion for case BBOP 06-04.

"The Rest of the Story"

An additional incisional wedge biopsy of the most nodular (anterior inferior red & white in photo) portion of the lesion initially showed microinvasive SCC, however, deeper sections showed a "rain drop" pattern of infiltration between muscles fibers, extending to the deepest resection margin. There was also perineural invasion. PAS stains are positive for occasional fungal pseudohyphae c/w Candida species.

The patient is booked for surgical management.

With 20:20 hindsight, the "correct answer" would be "6" - probability of malignant transformation "Certain & Very soon," ignoring most of the clinical data (strikingly clear history & physical evidence of constant mechanical trauma, which most of us no longer consider to be a serious oral carcinogen; she's NEVER used tobacco), as well as the results of the initial biopsy (competently read, but small & thus, in retrospect, likely not representative), in favor of the clinical appearance (idiopathic non-homogenous leukoplakia / erythro-leukoplakia) at a high risk site.

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