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I'm worried about this spot in my mouth...

The most common type of malignancy in the mouth is squamous cell carcinoma, which is a type of epithelial cancer. Other uncommon types of cancer include salivary histologic types, sarcoma, or lymphoma. The most significant risk factors associated with oral cancer are tobacco exposure, alcohol exposure, prior radiation exposure, poor oral hygiene, chronic inflammation, and viral exposure.

Oral lesions can have a variety of appearances or symptoms. A lesion is recognized as an area of altered color or texture. Alternatively, as some places in the mouth are difficult to visualize, a patient may present due to bothersome symptoms such as pain. A white lesion, called leukoplakia, is fairly common, and relatively low likelihood of being cancer, though could represent a precursor entity with some future risk of cancer.

Generally, a red and white lesion, called erythroleukoplakia, is more concerning. The red aspect could be either ulceration or a growth of vascular tissue.

The most important step regarding a concerning oral lesion is to have a biopsy done. This is typically a relative simple procedure which can be performed in the office with local anesthesia. A small portion of the lesion is incised and removed. It is important that this is a full-thickness incision of the lesion, so the full cross-sectional depth of the lesion can be evaluated by the pathologist.

If the lesion is not invasive cancer, but a premalignant lesion, some consideration can be given to whether the lesion can be prophylactically treated with an excision to remove it in entirety, and limit the risk of future transformation to cancer. For many of these lesions, the expected risk of cancer transformation is low enough, or a full excision impractical, so the lesions are observed and monitored over time for growth or changes in character.

If the lesion is an invasive cancer, then a surgery will be planned, which will be designed to remove the lesion completely with a wide rim of normal tissue buffer surrounding the invasive cancer. Imaging, either a CT with contrast or an MRI with contrast, is very important in this setting for guiding the planned surgical excision. In addition, this helps assess the state of the neck lymph nodes, which are at risk for metastatic disease from an oral cancer.

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