A study of the appearance of early asymptomatic oral squamous cell carcinoma

This is a study of the appearance of asymptomatic early squamous cell carcinoma documenting location, color, size, surface (texture, elevation, ulceration), presence of bleeding, induration, lymphadenopathy, and distant metastasis. Of 158 lesions, 143 (90.5%) had an erythroplastic (red) component, whereas only 98 (62%) had white components. Only 4 lesions were solely white. There was essentially no color distinction between invasive carcinoma vs. in situ carcinoma. One hundred forty-two (89.8%) lesions were located in the floor of the mouth, ventral or lateral tongue, or soft palate anterior pillar complex. One hundred twelve (70.9%) of the lesions in the study were invasive. Only 11 lesions were indurated, and these were all invasive. One hundred nine (69%) of all lesions were approximately 2 cm or less, and 37 (23.4%) were less than 1 cm. An erythroplastic (red velvety) lesion appears to be the earliest visible sign of asymptomatic oral squamous cell carcinoma—invasive or in situ. The presence of a white component did not appear to be significant unless it was accompanied by erythroplasia (redness). Minimal size (less than 1 cm) does not preclude the existence of an invasive carcinoma. The persistence of erythroplastic lesions for more than 14 days without obvious etiology requires biopsy.