A case of Squamous Cell Carcinoma (SCC) of the tongue in a young girl with no detectable risk factors

Background Oral cancer incidence in Sri Lanka is 1813/100,000 with male to female ratio, 3.55:1 and commonest after 55 years of age. SCC involves >90% of oral cancers. Oral SCC in young age shows weaker relationship with risk factors and more aggressive clinical course. Case Description 26 year old girl with no detectable risk factors for oral SCC, was presented with 2 month history of non healing solitary ulcer in the anterior 2/3rd of tongue left side. She had been treated for aphthous ulcer initially and due to poor response undergone excision. Excision biopsy revealed well differentiated SCC with positive margins. Radiologically no suspicious neck lymph nodes detected. Disease was staged as II (T2N0M0). Following multidisciplinary discussion, further excision with Supra Omohyoid Block Dissection performed. She recovered uneventfully. Histology confirmed the primary diagnosis with negative nodes, and underwent adjuvant treatment with brachytherapy. Discussion This patient didn’t give a history of alcohol consumption, tobacco use or beetle chewing, which are the commonest risk factors. Examination didn’t show any dentinal abnormalities causing chronic local irritation. Human Papilloma Virus (HPV) infection is a well known risk factor of oral SCC in west especially among young patients. Even though she denies of sexual contact still HPV testing would be beneficial, but difficult in local setup. Conclusions This highlights the need of early precise diagnosis, providing better prognosis, chance of better survival and quality of life for patient with SCC