Peripheral Oral Exophytic Lesions
Malignant SGTs are second to SCCs as the most common oral malignancy. The firm types are considered here. The fluctuant, mucus-producing varieties have necessarily been grouped in the differential diagnosis with retention phenomena. Like the early secondary tumors and early peripheral mal ignant mesenchymal tumors, the malignant SOTs originate in tissue situated deep to and separate from the surface epithelium. Consequently, in their early stages, they are nodular or dome shaped, have a smooth contour, and are covered with normal-appearing epithelium. Later, when their sUlfaces become ulcerated because of the trauma of mastication or biopsy or perhaps because of the rupture of retained fluid, they may appear to be malignant (i.e., have ulcerated, necrotic, friable surfaces). At this stage the malignant SGTs may not be readily differentiated from exophytic SCCs. The following clues, however, are helpful: I. SCC is not as common on the posterior hard palate as mal ignant SGTs. 2. SGTs occur more frequently in women, whereas SCC occurs 2 to 4 times as frequently in men. The signi ficance of this difference must be modified, however, because approximately 95% of the oral malignancies are SCCs, whereas only about 4% are malignant minor SGTs. 3. Malignant minor SGTs frequently maintain their overall nodular or dome shape even after their surfaces become ulcerated (see Fig. 10-26, C). Many rare oral exophytic lesions, including syphilis, fungal diseases, sarcoidosis, and tuberculosis, may be confused with exophytic SCC, but discussion of these possibilities is beyond the scope of this text.
Management The management of intraoral SCC is discussed in detail in Chapter 35.
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CHAPTER 10
VERRUCOUS CARCINOMA Verrucous carcinoma frequently has a white keratotic surface (see Fig. 8-25) and is discussed in detail with the white lesions in Chapter 8. On occasion, verrucous carcinoma develops as a nodular lesion or may present with a reddish, pinkish. and whitish surface (Fig 10-25 and Plate G). Its differential diagnosis in this context is discussed in the differential diagnosis section of exophytic SCc.
MINOR SALIVARY GLAND TUMORS Most of the minor SGTs are exophytic lesions. The intraoral minor salivary glands are predominantly of the mucous type and are normally distributed throughout the oral mucosa except for the anterior hard palate, attached gingivae, and anterior two thirds of the dorsal surface of the tongue. Unusual cases of SGTs occurring in the latter locations have been reported and are considered to have arisen in ectopic minor salivary glands. The mucous glands are not attached to the surface mucosa except by the common ducts that drain a cluster of glands. These clusters of mucous glands are situated deep to the surface and usually lie just superficially to the loose connective tissue layer. Consequently, as a tumor originates in these glands and enlarges, it becomes a nodular or dome-shaped exophytic mass with a smooth surface (see Chapter 3). Because of the great variety of neoplasms that occur in the salivary glands, the establishment and adoption of a uniform classification and nomenclature have been difficult. The boxes on p. 150 give a current classification for benign and malignant SGTs. (With only one or two exceptions, all the tumors occurring in the major salivary glands are also found in the minor salivary glands.)
A
B
Fig. 10-25. Exophytic verrucous carcinoma. A, Note the somewhat uniform. pebbil路. whitish-pink of this slow-growing lesion, which has a relatively pedunculated base. B, Broader-based lesion on the palate of an elderly patient. (A frolll Claydon RJ, Jordan JE: Verrucous carcinoma of Ackerman, a distinctive clinicopathologic entity: report of two cases, J Oral Surg 36:564-567. 1978: B courtesy B. Barker, Kansas City, Mo.)
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