CDA Essentials 2018 • Volume 5 • Issue 7

32 | 2018 | Issue 7 S upporting Y our P ractice In my examination of the patient, there was a fungating red and white mass with an ulcerated surface ( Figs. 1a and 1b ). At the right buccal mucosa, there was a non-homogenous red and white plaque (erythroleukoplakia) with an irregular speckled or corrugated surface. I asked the treating dentist to send the radiograph taken before the extraction ( Fig. 2 ). The periapical image of the tooth showed an endodontically treated tooth with a scoop-like and irregular moth-eaten appearance in bone, as well as the loss of lamina dura with root resorption. This is a relevant clinical finding because it had been about a year since the patient received the diagnosis of oral lichen planus, when it was actually a premalignant lesion. The unilateral presentation of the lesion should have been a red flag that further investigation is needed to rule out a premalignant lesion because the pathognomic feature of lichen planus is bilateral involvement of the posterior buccal mucosa. Certainly, not all red and white lesions on the buccal mucosa are oral lichen planus. But it’s very important to make sure that we do not misdiagnose the patient, because early diagnosis of the cancer is a key factor in improving patient outcomes and survival rates. Biopsies from both the protruding mass and red and white plaque on the right buccal mucosa showed squamous cell carcinoma with microinvasion. a Theviewsexpressedarethoseoftheauthor anddonotnecessarilyreflecttheopinions orofficialpoliciesoftheCanadianDental Association. firoozeh.samim@ mcgill.ca Case Report: A case of misdiagnosed oral squamous cell carcinoma Dr. Samim, assistant professor in the faculty of dentistry at McGill University, describes a case where a patient’s treatment of oral squamous cell carcinoma (OSCC) was delayed because it had been misdiagnosed as oral lichen planus. Figures 1a) and 1b) : Examination slide, buccal (a) and lingual view (b) . Figure 2: Radiograph before extraction. A 71-year-old male was referred to my office by a general dentist because an extraction socket had not healed, almost four months after the extraction had been performed. Three weeks post extraction, the patient’s dentist had performed a curettage on the site after the patient complained about a red mass extruding from the extraction socket. Another curettage was performed 2 months post extraction. The patient was diagnosed with lichen planus a year before by the same general dentist despite the unilateral involvement of the buccal mucosa. There was no history of a biopsy from the site. The patient was managed by corticosteroid rinse for a year. Visit Oasis Discussions to watch the full case presentation wp.me/p2Lv6A-63X Dr. Firoozeh Samim a b