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August 2003
By Youn W. Park, MD, and Y. T. Wu, MD
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CASE:
A 62-year-old man presents for evaluation of a lump with
a nonhealing ulcer on his tongue. He is a smoker and consumes
a moderate amount of alcohol daily.
WHAT IS YOUR DIAGNOSIS?
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Squamous cell carcinoma is the predominant malignancy of the
tongue. In cancer staging, the anterior two-thirds of the tongue,
demarcated by the circumvallate papillae, is classified as a
site in the oral cavity, while the posterior third is considered
part of the oropharynx. This is based on differences in biological
behavior between the two sites. The most common location of
squamous cell carcinoma on the tongue is along the lateral borders
of the middle third, as in this case. These cancers seldom produce
significant symptoms, but there may be pain and dysphagia at
a late stage. Metastases usually occur in the upper neck; occasionally,
bilateral spread may develop. At the base (oropharyngeal third)
of the tongue, these cancers are less common but more difficult
to diagnose and more aggressive, thus boding a poorer prognosis.
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Dr. Park is a clinical professor of otolaryngology
at Northeastern Ohio Universities College of Medicine and
section head of otolaryngology at Barberton Citizens Hospital
in Barberton, Ohio. Dr. Wu is an attending physician in the
department of family practice at Akron General Medical Center
in Akron, Ohio.
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