Microinvasive oral squamous cell carcinoma: A management protocol

Microinvasive oral squamous cell carcinoma (MISCC) is the early stage of oral cancer that shows a breach in the basement membrane, and the depth of invasion of the tumour is limited to 0.5-2mm into the papillary stroma. A review of the available data on MISCC was conducted to formulate a management protocol for MISCC and to assess the association of MISCC with oral potentially malignant disorders. An electronic and manual search of the articles was conducted following the inclusion and exclusion criteria. A total of 14 articles were selected, evaluated, and details were tabulated. Before finalizing the treatment plan, potential diagnostic errors on both the surgeon and pathologist's part and prognostic outcomes should be taken into consideration. An association between oral potentially malignant disorders and MISCC was observed in 12 out of 14 articles. According to the NCCN guidelines, elective neck dissection is only indicated in highly selective cases for a depth of invasion of less than 2mm. However, three out of 14 MISCC cases showed metastasis to lymph nodes during the follow-up period. Multiple recurrences and second primaries in the case of MISCC are also a matter of concern. Management protocol was formulated for MISCC considering the histopathological, clinical, and radiological presentation. Precise management of oral potentially malignant disorders with rigorous follow-up for at least 3 years is advisable to prevent their carcinomatous transformation. A follow-up period of 4-8 years in the case of MISCC is recommended as part of the management protocol.