title: Gingival squamous cell carcinoma: diagnostic delay or rapid invasion?
abstract: BACKGROUND
  The similarity between gingival squamous cell carcinoma (GSCC) and more common periodontal lesions may lead to a delay in diagnosis or misdiagnosis. Neoplastic lesions of gingival tissues are frequently diagnosed at an advanced stage.
  
  
  METHODS
  To assess the relative time from when patients first become aware of the problem to histopathologic diagnosis (total diagnostic time), 59 consecutive oral cancer cases were examined in this study. The following variables were considered: age, gender, smoking habits, tumor stage at diagnosis, and total diagnostic time. The median of the patients' total diagnostic time (1.5 months) was used as a cutoff point to distinguish between delayed and non-delayed cases. Analysis of the variables was undertaken using the Student t test and chi2 test, with a 95% confidence interval (CI).
  
  
  RESULTS
  The total diagnostic time was <1.5 months for 75% of gingival carcinomas, 50% of tongue carcinomas, and 78% of floor-of-the-mouth carcinomas. It was >1.5 months for 25% of gingival carcinomas, 50% of tongue carcinomas, and 21% of floor-of-the-mouth carcinomas. No significant differences in time before diagnosis were found when gingival cancers were compared to other oral tumors (chi2=0.21; 95% CI=-0.40 to 0.26). However, by the time of diagnosis, gingival cancers had invaded adjacent structures more frequently than other oral cancers (chi2=13.51; 95% CI=0.18 to 0.85).
  
  
  CONCLUSIONS
  The gingival location of oral squamous cell carcinoma (OSCC) was associated with advanced stages at the time of diagnosis, due to early invasion of contiguous bone tissue (T4-primary tumor). This would indicate that even earlier referral and diagnosis are necessary.
authors.affiliation: Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, and Primary Care Clinics, Galician Health Service, Burela, Lugo, Spain. jseoanel@usc.es
authors.forename: Juan
authors.initials: J
authors.lastname: Seoane
authors.forename: Pablo I
authors.initials: PI
authors.lastname: Varela-Centelles
authors.forename: Trevor F
authors.initials: TF
authors.lastname: Walsh
authors.forename: Jose L
authors.initials: JL
authors.lastname: Lopez-Cedrun
authors.forename: Ines
authors.initials: I
authors.lastname: Vazquez
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology; D016009:Chi-Square Distribution; D005260:Female; D005887:Gingival Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D013997:Time Factors