Volume 7 • 2020 • Issue 6

I n June, Dr. Firoozeh Samim diagnosed six patients with squamous cell carcinomas (SCC) on the lateral border of the tongue. Dr. Samim, a certified specialist in oral medicine and oral pathology at McGill’s faculty of dentistry, was surprised by the demographic of these patients: they were all professional women between the ages of 35 and 45 without the traditional risk factors associated with oral cancer. “In older textbooks, we all read that oral cancers like this were most common in elderly men,” says Dr. Samim. “Smoking and alcohol consumption are risk factors. But I’m seeing an increase among patients that don’t fit that profile.” Dr. Samim worries that she may have discovered an alarming new trend. “We need more research to find out why this is happening,” she says. “But first, I want to bring it to the attention of my fellow practitioners. We see our patients regularly, so dentists are often the first to diagnose oral cancers. And cancer that is found early has much better outcomes.” She recommends examining the whole mouth carefully, especially high-risk areas such as the lateral border of the tongue. Dr. Samim says that the clinical presentation of SCC may be different in younger people than older people. “In one of the patients that I diagnosed in June, the carcinoma presented as a shallow ulcer on the lateral border of the tongue,” she says. The ulcer was not indurated and didn’t have a rolled border. It had a slight yellowish pseudomembrane. The patient had bruxism and had been experiencing tongue pain for six months, which was diagnosed as traumatic pain and ulcer and treated with a night guard. “But the pain and ulcer did not resolve,” says Dr. Samim, “Fortunately, the patient continued to seek a diagnosis.” Dr. Samim’s biopsy revealed that the lesion was invasive SCC. “Often oral cancer doesn’t have pain as a symptom,” she says. “But five of the six young patients with oral cancer that I saw in June complained of tongue pain.” Dr. Samim’s advice for her colleagues? “Just because a patient is young, don’t assume that a lesion is caused by trauma only. If it doesn’t go away quickly, do a biopsy,” she says. Oral Cancer in Young Women Without Risk Factors Initially misdiagnosed, this lesion, which is not indurated and lacks a rolled border, was diagnosed as squamous cell carcinoma after a biopsy. Dr. Firoozeh Samim Certified specialist in oral medicine and oral pathology atMcGill’s faculty of dentistry Watch the whole conversation with Dr. Samim on CDA Oasis: bit.ly/3aTya2y S upporting Y our P ractice 33 Issue 6 | 2020 |