Hello Everyone

I had a pimple like lump on my hard palate, had it removed and biopsied.

Here is the biopsy report:

RIGHT PALATE BIOPSY:

MILD SQUAMOUS HYPERPLASIA WITH HYPERKERATOSIS.

COMMENT: THERE IS NO DYSPLASIA OR MALIGNANCY IDENTIFIED. THERE IS PROMINENT DIFFUSE PIGMENTATION OF THE BASAL EPITHELIAL CELLS.
THE UNDERLYING STROMA SHOWS FOCALLY THICKENED
COLLAGEN BUNDLES.


The pathology report(biopsy) is from AMERIPATH.

Oral surgeon said it is not cancer. should I said the slides for second opinion?.


what SQUAMOUS HYPERPLASIA means? I am worried about the word SQUAMOUS in the biopsy report.

thanks a lot for reading this message

Hi,
I'm not a Doctor, so take this into consideration. My understanding of the term "squamous" refers to a flattening and thickening of tissue. It is a defining term for a variety of situations, only a few of them cancer.

The hyperplasia also refers to irritation. The words you really need to key on came from your oral surgeon; " NOT CANCER"

That's what we all want to hear most. You should keep an eye on it; pre-cancerous lesions that are detected and dealt with before they become cancers are easy; it's when the words "carcinoma" "sarcoma", "melanoma" start appearing in biopsy reports that things get..."busy"

Congratulations on NOT having Oral Cancer!
Wayne

Hello Dragan how are you?

thanks a lot for the message.

is it pre-cancerous lesion, what should I do from
now onwards before it becomes cancer. I dont smoke
and drink. I am 31, dont have family history of oral cancer. I had braces in the past.
Is there any medication for pre cancerous lesions?

How are you doing? how is your recovery from surgery and radiation. It seems you found it very early. Good luck to you.

"Squamous" simply refers to the type of cell and has nothing to do with whether cancer is present.

From the National Cancer Institute's dictionary of cancer-related terms :

squamous cell: Flat cell that looks like a fish scale under a microscope. These cells cover inside and outside surfaces of the body. They are found in the tissues that form the surface of the skin, the lining of the hollow organs of the body (such as the bladder, kidney, and uterus), and the passages of the respiratory and digestive tracts.

hyperplasia: An abnormal increase in the number of cells in an organ or tissue. (Note: some websites go a little farther in the definition, calling it an unusual increase in the number of normal cells.)

hyperkeratosis: A condition marked by thickening of the outer layer of the skin, which is made of keratin (a tough, protective protein). It can result from normal use (corns, calluses), chronic inflammation (eczema), or genetic disorders.

Bottom line: This report says it is not cancer. If the pathologist had used the word "dysplasia" to describe the biopsy -- and yours specifically ruled that out -- that would indicate an "in-between" stage: not normal, but not cancer. Those should get further examination and, possibly, removal.

That said, if you notice something unusual or bothersome and it does not go away after two weeks, give yourself peace of mind and get it looked at.

All the best,
Leslie

Columbus-guy, I'm doing pretty well, thanks for asking. Actually my tumor was at stage IV when I was diagnosed...it moves quickly and tends to be aggresive. I was lucky to have some of the best medical expertise in Canada, right in my back yard. Treatment was as good as it gets, and everything is looking good.

There is nothing that you can take specifically that will ward off cancer. Good eating habits, brushing your teeth regularly and maintaining good oral hygene, and generally living a healthy lifestyle are the things to do.

As Leslie said, the best defence is vigilance. If you see something unusual, get it checked.
You're on a forum right now with a TON of people who practice that vigilence through close, regular self-examination of their mouths. It only adds a few seconds to your tooth-brushing ritual, and it could save your life
Wayne

Leslie

Thank you for your message. I follow your suggestion from now on, regularly checking for something unusual in mouth, if dont go away in two weeks see a doctor.

it seems the sequence is hyperplasia, dysplasia and then carcinoma(cancer). Is there any time frame between these stages or just pure luck and depends on each individual.


Wayne

good to know that you had best medical expertise near your home. Having good hospital near home is always good thing. take care and my best wishes to you.

Wayne --

I do not believe that the sequence is as you describe it, and certainly not all areas identified in a biopsy as dysplasia progress to cancer.

My husband's initial biopsy did show moderate dysplasia, and an fuller excisional biopsy showed carcinoma in situ, with a small bit superficially invasive. But he sees his dentist -- who identified the tiny white patch that was biopsied -- regularly, and she never said anything about hyperplasia, nor did any biopsy report.

All the best,
Leslie

Hi Leslie

How did the dentist gave dx w leukoplakia in your
husbands case. Why i am asking this is leukoplakia
means Squamous cell hyperplasia which is in my biopsy report.

My biopsy report says mild Squamous hyperplasia which is mild hyperplasia.

Oral surgeon took a tissue measuring 0.6cm * 0.3cm * 0.2cm from my hard palate.

Do I need to take one more biopsy with more tissue
available for pathology?

Thank you for your time

Leslie

can you read this http://carcin.oxfordjournals.org/cgi/reprint/bgi326v1.pdf

here they mentioned

Over 80% of Oral cancers are squamous cell carcinomas where the neoplastic process develops
in squamous epithelium, progressing through hyperplasia and dysplasia to Carcinoma in situ and eventually invasive carcinoma.


Thank you

Wayne --

My knowledge, such as it is, is based on my husband's case, along with reading I have done on this site and elsewhere and conversations with his doctor. I am in no position to tell you whether to seek an additional biopsy (I'm an editor, not a doctor), but I can tell you that your report is one that many members of this site would be thrilled to have.

The NCI dictionary I cited above defines leukoplakia as "an abnormal patch of white tissue that forms on mucous membranes in the mouth and other areas of the body" and adds: "It may become cancerous" (emphasis mine). In my husband's case, his dentist noticed a tiny white patch on his tongue that had not been there on his previous visit and arranged for the initial biopsy.

When I first asked about leukoplakia (after the initial biopsy and before the excisional biopsy, done by an ENT, when we learned he was dealing with cancer), Brian responded to my questions this way:
[quote]Leukoplakia is a PRE-cancerous condition that does not always move completely into malignancy. Dysplasia are those cells which are no longer normal, but they are not really malignant yet -- an in-between state, so to speak. Dysplasias also do not always go completely over to the dark side, but they are a step in that direction -- and having them removed or watched very regularly is prudent.... Keep an eye on things even after the removal from now until forever. [/quote]And just because the progression can go from hyperplasia to dysplasia to carcinoma in situ to invasive cancer (as referenced in the article in the Oxford journal Carcinogenesis that you cite and which requires a subscription to read) does NOT -- as Brian notes -- mean that it always does.

All the best,
Leslie

Hi Leslie

Thank you for the post

If I understand you correctly after having initial biopsy you came to know that it is leukoplakia, could you please tell me what made you to go for excisional biopsy. Did the ENT recomend it or just for precausion you had it.

Thank you for your time

My husband's dentist identified the tiny white spot on his tongue as a leukoplakia last April and then referred him to an oral surgeon for the initial biopsy. That report came back showing moderate dysplasia. It also specifically warned of a possible "skip effect" -- meaning that more severe dysplasia or cancer cells could be hiding in areas that were not removed in the initial biopsy.

Given that report, the oral surgeon referred my husband to a local ENT surgeon (not one at an NCI-designated cancer center, since cancer had not yet been diagnosed) for an excisional biopsy. That was done a month after the initial biopsy, and a larger area was removed. The report came back showing carcinoma in situ, with a bit superficially invasive.

After getting that diagnosis, my husband began to see an ENT at Johns Hopkins' Kimmel Cancer Center, about an hour away from our home. He was checked there every four to six weeks for the first six months and is now being seen every eight to 10 weeks. All good so far (knock on wood).

All the best,
Leslie

We've got some wrong info going on here. Squamous refers to the type of tissue that something is occurring on, nothing more. So carcinomas that occur on the squamous cells of the body are SCC. Hyperplastic tissues are common. These are tissues that have grown at a fast (more than normal) rate. In the world of implants we frequently see patients who are prolific tissue growers around the neck of new implants, and the hyperplasia causes the tissue to grow up around the implant and get in the way of the crown fabrication. It is usually just removed with a cautery and may have to be done repeatedly. This is not disease. Leslie's definition of hyperkeratosis is correct. This is not irritation, though irritation can be a cause of hyperkeratosis in some cases. We have to be really careful that we are giving people accurate information here. Clearly SCC has a path of gradual changes that may or may not be detected as final malignancy develops. These steps are well documented and understood. But realize that anywhere along this path things may stay idle for years or never progress further. So having an early step in the process is no guarantee that it will become more. This does not mean that you should be complacent; it means that you have to keep you eye on things and if changes take place, reevaluate what the cellular issues are at that point in time. I have a plaque on the panel of my plane and it applies to this as much as it does to flying. Eternal vigilance or eternal rest.

Leukoplakia can continue transformation to cancer. But only about 25% of the time is this true. Nevertheless, I am an advocate of having it lasered off as a precautionary and proactive process. It often returns. I know people that have had repetitive, annual laser removal of this sometimes precancerous lesion.

Avoiding biotechnical terms, I started having recurring white spots on my tongue over 15 years (1990 - 2005), which were removed and sometimes lasered, but in my case eventually a tumor started at that spot -- I had stopped smoking in 1970 (after eight years) and stopped all alcohol in 1994, but had a tooth rubbing that spot until the tumor started (my surgeries removed enough of my tongue in that area that it no longer contacts my teeth).