Early squamous cell carcinoma of the anterior tongue; Report of two cases

Abstract

Squamous cell carcinoma (SCC) of anterior tongue is relatively common in India and forms a significant group of all head & neck malignancies. Mucoepidermoid carcinoma, melanoma and adenoid cystic carcinoma are other rare tumors found in the tongue. The purpose of this article is to report two cases of early SCC of anterior tongue which were managed with wide excision. The incidence, etiology, treatment and prognosis are discussed. th and 6 th decades but cases have been reported in young individuals too. Carcinoma of tongue is associated frequently with alcohol and tobacco chewing as a common etiology. The anterior tongue is a movable portion and extends from circumvallate papillae to the junction at the anterior floor of mouth. The anterior tongue is divided into four regions, tip, lateral borders and dorsal & ventral surfaces. Lymphatic drainage from anterior aspect is into submental nodes, and the lateral borders drain into the submandibular and upper deep jugular nodes and communications which occur in the midline can lead to contralateral neck drainage. The various treatment options for carcinoma of anterior tongue are wide excision, hemiglossectomy and primary excisions alongwith elective neck dissection. Here we show report of two cases of carcinoma of anterior tongue. II. Case reports Case 1 A 40 year old man reported to hospital with the complaint of a non healing ulcer over the tongue, since 3 months. It was initially small and it gradually progressed to present size. History revealed the habits of betel nut chewing and smoking. Clinical examination showed a ulcerative lesion in right lateral border of the anterior tongue, measuring 0.5X2.cm (fig.1). Neck nodes were not palpable and on palpation of the tongue induration was there but not crossing the midline.Incisional biopsy revealed moderately differentiated squamous cell carcinoma.(fig.2) Surgery was planned as wide excision of the lesion under general anesthesia. Wide excision is done with adequate safe margins.(fig.3)Hemostasis is achieved and primary closure is done.(fig.4) The post operative recovery was uneventful. The excised lesion was sent to histopathology for assessing margins and depth of tumor extension. Histopathology report suggested that all margins are free and the depth is less than 4mm. Follow up has been done for 2 years and there is no sign of recurrence. Case 2: A 30 year old male patient reported to hospital with ulcer over the tongue since one month. Clinical examination revealed a lesion of 1x1.5cm in anterior tongue.(fig.5) There were no palpable lymph nodes. Incisional biopsy is suggestive of well differentiated squamous cell carcinoma of tongue.Wide excision of the lesion is done under general anesthesia . Postoperative histopathology report was suggestive of well differentiated squamous cell carcinoma, with all clear margins and tumor thickness being less than 3 mm. Follow up has been done for 3 years. There is no report of recurrence.