A Case of Bilateral Palatal Primary Squamous Cell Carcinoma

Objectives: Cancers presenting bilaterally are extremely rare, and it is even more uncommon that bilateral, primary cancers are found in the oral cavity. The etiology of oral squamous cell carcinoma is multifactorial with risk factors including tobacco use, alcohol consumption, HPV and environmental factors. A 73-year-old male patient was referred to ECU School of Dental Medicine with a presentation of synchronous bilateral SCC on the palate adjacent to tooth #3 and #15. The purpose of this case report is to increase awareness regarding bilateral SCC.
Methods: Upon evaluation, patient reported being a former smoker as well as drinking alcohol occasionally. Medical history included renal disease, lung disease, sleep apnea, and arthritis along with a surgical history of aortic valve replacement. The patient’s medications included tamsulosin, warfarin, furosemide, metoprolol and amiodarone. The right side presented with a red and white pedunculated lesion (15 mm X 15 mm) with rolled borders. On the left side, a red and white sessile lesion (10 mm X 5 mm) with rolled borders was detected adjacent to the maxillary second molar.
Results: This case presents a very rare and unusual occurrence of primary bilateral squamous cell carcinoma that required a maxillectomy, excision of the right palate, as well as bilateral neck dissections upon cardiac clearance.
Conclusions: To the best of our knowledge this is the only case of bilateral SCC on the palate that has ever been diagnosed. Due to the rarity of this phenomenon, it is difficult to know the prognosis as well as the etiology. Clinicians should be suspicious of any abnormal presentation of a persistent oral lesion and be aware that oral SCC, though extremely rare, can occur bilaterally. Therefore, it is important to approach lesions with an open mind and remember the saying, “Never say never and never say always.”