Upon histologic confirmation of the diagnosis, referral was made to an otolaryngologist specializing in head and neck oncology for additional work-up and definitive treatment. Because of the size and duration of the lesion, both a wide local resection of the lower lip and a supra-omohyoid neck dissection was performed.

Incisional and excisional biopsy

Histological examination revealed a piece of oral mucosa exhibiting epithelial changes invading the underlying fibrous connective tissue. The epithelial cells show evidence of alteration in the nuclear/cytoplasmic ratio, loss of maturation, large nuclei with prominent nucleoli, increased mitotic activity and mild nuclear and cellular pleomorphism (Figure 2). Individual cell keratinization and keratin pearls are also present (Figure 3). Also present are clusters of foreign body type giant interpreted as foreign body reaction to keratin.


Figure 2H & E stained section at screening 100X magnification demonstrating neoplastic epithelial cells invading the connective tissue in form of islands.

Figure 3 H & E stained section at 200x magnification demonstrating neoplastic epithelial islands with keratin pearl formation and cells with hyperchromatic nuclei and prominent nucleoli.