A cautionary tale; squamous cell carcinoma of the gingiva

Oral squamous cell carcinoma is characterised by varied clinical manifestations and is often diagnosed at an advanced stage. This article highlights a case of gingival squamous cell carcinoma which was initially diagnosed and treated as localised periodontitis.

A 64-year-old Caucasian male had a 2-year history of discomfort and swelling around his upper anterior teeth. His dentist diagnosed localised periodontitis around tooth 11. The patient was treated with regular scaling but showed no improvement. Teeth 11 and 21 were subsequently extracted. He returned later with a swelling in his anterior maxilla and was referred to the Whangarei Hospital Dental Department.

The histopathological report confirmed a diagnosis of squamous cell carcinoma. The patient was referred to Auckland for treatment and underwent a tracheostomy, maxillectomy, bilateral selective neck dissection and fibula free flap reconstruction. All lymph nodes retrieved and margins of the lesion were clear, and the patient did not require radiotherapy. He will be monitored over the next 5 years for recurrence.

Gingival squamous cell carcinoma can be easily misdiagnosed. Suspicious lesions which are non-responsive to conventional therapy should be biopsied, even if they are not in the classic high risk anatomical areas of the oral cavity.