[Delayed diagnosis of carcinoma of the oral cavity]

Approximately 4% of cancers are located in the mouth and pharynx, 95% of which are squamous cell carcinoma (SCC). The case fatality rate of SCC is very high 50%, but early diagnosis significantly lowers the fatality rate. Diagnosis and treatment of oral lesions are shared by numerous specialists including dermatologists, otolaryngeologists, family physicians, general dentists and specialists in oral medicine and in oral surgery. The article describes a patient who was referred to a dermatologist because of a lesion of two months duration on the lateral aspects of the tongue. The dermatologist clinically diagnosed an apthous ulcer and treated it as such. When he returned after two and a half months after no clinical improvement he was diagnosed as suffering from candidiasis and treated accordingly. The unsatisfied patient turned to another dermatologist who referred him to a specialist in oral surgery. He immediately performed a biopsy. SSC was diagnosed, one third of the tongue was resected as well as the submandibular lymph nodes and salivary gland. An Israeli study has demonstrated that dentists performed better than physicians from general medical specialist fields in diagnosing early stage oral cancer. The authors suggest that patients suffering from oral lesions should be referred to specialists in oral medicine or in oral surgery for the diagnosis of oral lesions in order to diagnose oral cancer earlier.