Occasionally, a patient will present with an oral mucosal lesion for which further diagnostic work-up is important to rule out a precancerous or cancerous condition. Typical risk factors for such lesions include tobacco use and alcohol abuse, the cumulative injury from which produces clinical lesions in older patients. However, a recent trend for some younger patients (eg., ages 25-40 years) to develop oral SCC in the absence of identifiable risk factors including tobacco or immunosuppression has raised the possibility that additional causes of the condition may exist.

Oral SCC may present as white, red, or mixed white and red lesions. Specific terminology has been established to allow for careful decision-making by the dentist during the evaluation. For example, leukoplakia is a term used clinically to describe a fixed, white lesion of unknown etiology and that cannot be removed with gentle scraping (Figure 1). It is important to biopsy these lesions in order to establish a definitive diagnosis. If left untreated, these lesions have a clinically significant (approximately 20%) risk for transformation to frank carcinoma (Table 4). Erythroleukoplakic lesions have a higher risk for dysplastic and neoplastic transformation than do leukoplakic lesions.