 hello everyone welcome back to another session in dentistry and more today we have epidermoid carcinoma which is also known as squamous cell carcinoma or SCC so which is the most common malignant neoplasm of the oral cavity and it is a neoplasm which exhibits squamous differentiation as characterized by the formation of keratin and the presence of intercellular bridges so keratin formation and intercellular bridges and most specifically squamous differentiation so let's learn the most common malignant neoplasm of the oral cavity so as I mentioned squamous of carcinoma it is a malignant neoplasm exhibiting squamous differentiation and characterized by formation of the keratin and or the presence of intercellular bridges so the male to female ratio is 2 is to 1 most commonly seen in males and mainly found in the elder age group after the fourth decade so after the fourth decade is most commonly seen in male group and the mortality rate is lowest for lip cancer and highest for the tongue so lip is the lowest and highest is for tongue cancer so it could be anywhere on the tongue like lips tongue buckle mucus the floor of the mouth palate and most common site is tongue and the least one is lip so etiology is as we all know tobacco is in its various form like smokeless tobacco which is a main cause especially when coupled with excess alcohol and also high exposure to ultraviolet radiation is a predisposing factor also look up lick here poor oral hygiene diet with low levels of vitamin A and vitamin C A and C and inadequate consumption of fruits and vegetable which is also a contributing factor patients who are immunosuppressed they are also in predisposed group and rare conditions like 0 derma pigmentosa and also risk factor for oral cancer has been shown to increase in the presence of human papilloma infection so these are the etiological factors of scoma cell Casinoma whereas moving on to clinical features the all cancers have two very characteristic features in the form of one is ulceration and the second one is an inturated margin so these are the typical two striking features of scoma cell Casinoma now in histology types we have three major types in histology classification histology types are well differentiated well differentiated well differentiated is slightly towards malignant region or the prognosis also is better in well differentiated group it consists of sheets and of cells with obvious origin from the scoma epithelium and cells are usually large and show a distinct cell membrane although intercellular bridges often cannot be demonstrated nuclei are large and may demonstrate a good deal of variability in staining mitotic figures may be found many of which are atypical and the most prominent features are individual cell individual cell keratinization ok individual cell keratinization and the formation of keratin pulse so these are the two striking features of well differentiated group whereas the moderately differentiated that is the second one moderately differentiated moderately differentiated where the tumor resemblance to the scoma epithelium is less pronounced this is more of scoma epithelium it is less pronounced towards the scoma epithelium and the characteristic shape of the lesion that is the shape of the cells not lesion cells may be altered and the growth rate is more rapid compared to the well differentiated and greater numbers of mitotic figures and they fail to form keratin the third type is poorly differentiated poorly differentiated is very little resemblance to the cell of origin and will present diagnostic difficulties the prognosis of poorly differentiated is very difficult or very minimal I mean the recovery is very difficult with respect to poorly differentiated group and this is like a stage 3 or 4 cancer this is the beginning stages stage 1 and stage 2 and metastasis involve chiefly submaxillary and superficial deep cervical lymph nodes so submaxillary and deep cervical lymph nodes deep cervical lymph nodes so towards these nodal groups it will be metastasis and the basic three types of differentiated moderately differentiated and poorly differentiated so as I mentioned scoma cell cosinoma are of various type the first one is cosinoma of lip cosinoma of lip which occurs in elderly main especially in the lower lip and it is most common cause is as we all know it is tobacco or through pipe smoking clinical features are begins with our begins on the vermalion border of lip on one side of the midline and often starts as a small area of thickening or in duration and ulceration it enlarges then create a small crater like defect or produce an exophytic proliferative so sometimes it will be exophytic or sometimes a crater like depression so it is generally slow to metastasis and this if it is occur then it is going to ipsilateral nodes and involves a submental or submaxillary nodes so contralateral metastasis may occur only if the lesion is near the midline otherwise it is going only to the one side okay if it is going either side it should be on the towards the midline and treatment we do either surgical excision or x-ray treatment and usually it has a good prognosis whereas the tongue which has a least prognosis so it is suggested that the syphilis and tongue cosinoma there is a relationship but nothing has proved it so clinical features are a pain less mass or ulcer which might become painful if it is secondly infected it begins as a superficially intuorator ulcer with slightly raised border and may develop into fungating exophytic mass fungating exophytic mass that is in tongue okay so there will be infiltration to the deeper layer of tongue producing fixation and inturation develops on the lateral borders or the ventral surface of the tongue so lesion on the posterior portion are usually of a higher grade of malignancy and easily go on metastasis and offer a poor prognosis if it is on the posterior part of tongue because of its inaccessibility for a treatment so anterior part we can go for a surgical excision or the posterior part the accessibility and it is a poor prognosis when it is on the posterior part posterior part poor prognosis and treatment and as I mentioned treatment is very difficult as the efficacy of it depends on the efficacy of surgery and prognosis also very poor so the squamousl cosinoma the least prognosis is seen in tongue so whereas a cosinoma of floor of the mouth okay floor of the mouth when smoking especially pipe or cigar it is a most important in etiology it is an indurated ulcer of varying size situated on one side of the midline more frequently on the anterior portion of the floor because its location early extension into lingual mucus of the mandible and then it goes to the tongue even to the sub maxillary or sublingual glands so sometimes it may produce limitation or the motion of the tongue or slurring of the speech slurring of the speech or tongue movements it may affect these two things tongue movements and slurring of the speech so contralateral metastasis is common as a primary lesion occurs mostly on the midline so surgical part it's also like we need to go for a radiation therapy it gives better results than the surgery whereas a cosinoma of buckle mucosa so it is most commonly seen in men and etiology it is in area against the person has habitually carried a kid of chewing tobacco so smokeless tobacco where they used to keep in buckle vestibule and it creates a change in the epithelium which leads to conical cast on of buckle mucosa and clinical features usually develops along the inferior to align opposite the plane of occlusion so it is a plane of occlusion so it is seen the below the line of occlusion where the buckle vestibule and where the people usually keeps the tobacco pouches so lesion is often a painful ulcerative one where the enduration and infiltration of deeper tissue is common some lesions may even be exophytic and metastasis is very frequent so treatment we need to do a combination of surgery and x-ray radiation the cosinoma of ginger the problem is its similarity to common dental infection has frequently led to the delay in diagnosis or even misdiagnosis with respect to ginger because the periapical lesions periapical abscess all those may cause the delay in diagnosis so cosinoma of ginger was another problem which commonly found in the mandibular ginger which initially present as an area of ulceration which may be purely erosive or may exhibit exophytic growth purely erosive or exophytic and it arises more commonly in identulous areas and fixed ginger that is attached ginger is commonly involved than the marginal ginger erosion of the underlying bone is frequent and metastasis is more common from the mandibular ginger and treatment also similarly we need to combine the surgical and radiation and cosinoma of pallet is not a very common lesion which the clinical features include poorly defined ulcerated painful lesion on one side of the midline it frequently crosses the midline and may extend laterally to include the lingual ginger or posteriorly to involve the tonsillarpular or even the uvula so that is metastasis also is common now we wind up the scomassal cosinoma so scomassal cosinoma is most common type which has three different category it is well differentiated moderately differentiated and poorly differentiated depends on the histological features and prognosis also inferior with respect to the poorly differentiated so we have scomassal cosinoma of lip tongue floor of the mother Jinjai Babakal Mekosa and pallet it is a commonly asked essay question so next I'll come up with a another cosinoma in dentistry and more thank you