The oral pericommissural region: a distinct subsite—clinical features, histopathology, and treatment outcomes in 25 cases of squamous cancer

Abstract

Oral squamous cancers constitute a large proportion of head–neck malignancies in India. One subset of oral cancers includes lesions arising in the oral commissure and the mucosa around it. These are unique in their location and pattern of spread with even small lesions affecting oral competence, function, and cosmesis. This study was done to analyse such “pericommissural” cancers and to explore if they should be placed in a distinct subcategory of buccal cancers with different implications for management and prognostication. 25 cases of pericommissural squamous cancers were studied. Presentation, extent, differentiation, nodal metastases, and treatment outcomes were evaluated. Cancers of the pericommissure made up 8.7% of oral cancers that were treated surgically between 2013 and 2015. All cases underwent upfront surgery with neck dissection and reconstruction with local flaps. 36% cases were staged pT4; 12% cases had nodal involvement. 40% patients received adjuvant treatment. After a median follow-up of 676 days, there were no recurrences. Five patients died of unrelated causes and one patient died of a second primary in the lung. Functional and cosmetic outcomes were measured objectively as well as subjectively; patient expectations were taken into consideration and the scores were satisfactory. Pericommissural squamous cancers show a distinct behaviour and it may be helpful to place these lesions in a separate subcategory of oral cancers. Functional and cosmetic aspects are as important in their management as is disease control.