oral squamous cell carcinoma ( oscc ) is the most common oral malignancy , representing up 
 to 80 - 90% of all malignant neoplasms of the oral cavity . although oral cancer incidence is highly variable 
 worldwide , it is accepted that oral cavity ranges from the 6 to the 
 9 most common anatomical location for cancer , depending mostly on the 
 country ( and even specific region in some countries ) and gender of the 
 patients . despite this mean 
 incidence , it can represent the most common location for cancer in some specific 
 regions , especially in southeastern asia . major etiological and predisposing factors for oscc include mostly 
 smoking and drinking habits , and ultraviolet radiation ( specifically for lip cancer ) , 
 but several other factors such as human papillomavirus ( hpv ) and 
 candida infections , nutritional deficiencies and genetic 
 predisposition have been also associated . oscc is a disease of 
 adults and elderly and its most common clinical aspect is an ulcerated lesion with 
 necrotic central area surrounded by elevated rolled borders . although the main demographic and clinicopathological information on oscc can be similar 
 in most studies , it is accepted that some features can be quite variable from country to 
 country and even from different regions in the same country . as there are 
 few studies presenting oscc clinical and pathological profile in brazilian 
 populations , the aim of this study is to report the demographic and 
 clinicopathological features from a series of oscc diagnosed in an oral pathology 
 service in brazil in an 8-year period . the files of the oral pathology service , school of dentistry , state university of rio de 
 janeiro , brazil , were reviewed from 2005 to 2012 and all registries diagnosed as oscc 
 were retrieved . after individual analysis of all registries , the cases diagnosed through 
 cytological methods ( smears and fine - needle aspiration biopsies ) , originated from 
 maxillofacial areas apart from the oral cavity and presenting inadequate material for 
 histological review and classification were excluded . when more than one biopsy was 
 performed in the same patient for the same lesion , all registries were reviewed , but 
 only the most representative histological section was included . demographic and clinical 
 information from all cases were obtained through review of all forms submitted with the 
 specimens , and included gender , age , time interval before diagnosis ( in months ) , 
 clinical aspect , location and size ( in centimeters ) of the tumors and risk factors 
 ( tobacco and alcohol use ) . clinical aspect of the lesions was divided in three groups : 
 ulcers ( including plain ulcers , and exophytic ulcerated masses ) , leukoerythroplakias and 
 tumors presenting both ulcers and leukoerythroplakic areas . location of the tumors 
 included the following regions : border of tongue ; floor of mouth ( with extension to 
 ventral tongue ) ; alveolar mucosa and gingiva ( including retromolar area ) ; buccal mucosa 
 ( including buccal sulcus / mucobuccal fold ) ; soft palate and tonsil area ; lower lip ; and 
 others ( in cases with no precise information about the primary location ) . all hematoxylin and eosin ( he)-stained histological slides were reviewed for diagnosis 
 confirmation and for classification of the tumors as well - differentiated ( wd ) , 
 moderately differentiated ( md ) and poorly differentiated ( pd ) tumors and in oscc 
 variants , according to recently published accepted criteria . all information were descriptively analyzed and statistical analysis was performed using 
 a standard program ( statistical package for social sciences , spss version 17.0 , chicago , 
 il , us ) , with statistical significance level of 5% ( p<0.05 ) . distribution of group 
 variables was compared in crosstabs by pearson chi - square and comparison of means was 
 performed with t test . this study was approved by the ethics committee , state university 
 of rio de janeiro ( protocol number 044.3.2010 ) . a total of 346 oscc were selected for the study after using the inclusion and exclusion 
 criteria . this total represented about 65% of all oral malignancies diagnosed in the 
 laboratory on the selected period . males represented two thirds of the affected patients 
 ( 232 cases , 67% ) with a male : female ratio of 2:1 . mean age of all patients was 62.3 
 years ( standard deviation - sd13.2 , ranging from 30 to 102 years ) ; mean age of the 
 males ( 59.9 years , sd10.9 , ranging from 30 to 87 years ) was almost a decade lower than 
 mean age of females ( 67 years , sd15.9 , ranging from 32 to 102 years ) ( p<0.001 ) . more 
 than 80% of the patients were diagnosed in their forties to seventies and 3% of the 
 patients were younger than 41 years ( table 1 - 
 demographic and clinical features are included according to the number of cases for each 
 parameter for which precise information was available ) . demographic and clinical features from the oral squamous cell carcinomas from the 
 studied sample ( number of cases for each parameter includes the number of 
 registries with precise available information ) mean time of complaint with the lesions reported by the patients before diagnosis was 10 
 months ( sd20.8 , ranging from 1 to 123 months ) and most patients reported to have 
 noticed the lesions up to 6 months before diagnosis ( 169 cases , 73% ) . mean time of 
 complaint was longer for females ( 14.9 months , sd26.5 , ranging from 1 to 120 months ) 
 than for males ( 7.6 months , sd16.9 , ranging from 1 to 123 months ) ( p=0.03 ) . site 
 distribution showed that the most common location of the tumors was the border of the 
 tongue ( 37% ) , followed by the alveolar mucosa and gingiva ( 20% ) and floor of the mouth 
 and ventral tongue ( 19% ) . clinical aspect of the tumors revealed that ulcers , ulcers 
 associated to leukoerythroplakias and leukoerythroplakias represented , respectively , 
 62% , 21% and 17% of the sample . mean size of the tumors showed that most oscc were 
 diagnosed with up to 4 cm in their greater diameter ( 76% ) , showing a mean of 3.4 cm 
 ( sd1.9 , ranging from 0.2 to 12 cm ) . there was no difference on the mean size of the 
 tumors when comparing affected males ( 3.6 cm , sd1.9 , ranging from 0.2 to 12 months ) and 
 females ( 3.1 cm , sd1.9 , ranging from 0.3 to 10 months ) ( p=0.091 ) ( table 1 ) . information about tobacco use was 
 available for 281 patients and showed that 225 patients ( 80% ) were present or past 
 tobacco users . for alcohol use , information was available for 208 patients and showed 
 that 146 patients ( 70% ) were present or past alcohol users ( table 3 ) . distribution of the clinical aspect of all oscc , site of the lesions , history of 
 tobacco and alcohol use and histological grade of the tumors according to the 
 gender of the affected patients including solely well , moderately and poorly differentiated tumors   histological diagnosis and grade of the tumors rendered after analysis of the he - stained 
 slides revealed that , from 303 cases of conventional invasive oscc , 93 cases ( 30.7% ) 
 were classified as wd oscc , 138 cases ( 45.5% ) as md tumors and 72 ( 23.8% ) as pd tumors . although there were some differences on the histological grade of the tumors when 
 comparing each location , these results were not statistically significant ( p=0.381 ) 
 ( table 2 ) . from the remaining 43 oscc 
 samples , 26 cases ( 7.5% ) were diagnosed as microinvasive oscc and the remaining 17 cases 
 were diagnosed as oscc variants , including 9 verrucous carcinomas ( 2.6% ) , 5 spindle cell 
 carcinomas ( 1.4% ) , 2 basaloid oscc ( 0.6% ) and 1 papillary oscc ( 0.3% ) . distribution of the histological grade of the tumors according to the site of the 
 lesions * total number of cases reflect the number of conventional invasive oscc with 
 precise anatomical location ; wd - well differentiated ; md - moderately differentiated ; p value=0.381 ( pearson chi - square ) clinical aspect of the tumors from the whole sample showed that the presence of ulcers 
 was more common in males ( p=0.017 ) while leukoerythroplakias were more frequently found 
 in females ( p=0.001 ) . distribution of the site of the tumors revealed that oscc in males 
 mostly affected the border of tongue , floor of the mouth / ventral tongue and alveolar 
 mucosa / gingiva , while they were more frequent on the border of tongue , alveolar 
 mucosa / gingiva and buccal mucosa / buccal sulcus in females ( p=0.004 ) . past and present 
 tobacco and alcohol use were more common in males than in females ( p<0.0001 , both ) . distribution of the histological grade of the conventional invasive oscc ( n=303 ) was 
 also different when comparing the gender of the patients , as males were predominantly 
 affected by md and pd tumors , while females presented mostly with md and wd tumors 
 ( p=0.004 ) ( table 3 ) . microinvasive carcinoma equally affected males and females with a mean age of 67.2 years 
 ( sd13.05 , ranging from 42 to 87 years ) . mean time of complaint was 18.4 months 
 ( sd22.7 , ranging from 1 to 72 months ) and most lesions showed leukoerythroplakic areas 
 ( 73.1% ) , while ulcerated areas were found in 50% of the cases . the tumors affected 
 mostly the border of tongue ( 56% ) and lower lip ( 16% ) . size of the tumors showed a mean 
 of 1.9 cm ( sd1.6 , ranging from 0.2 to 6 cm ) and most patients reported no tobacco 
 ( 52.6% ) and alcohol ( 53.3% ) use . verrucous carcinoma mostly affected the elderly with a 
 mean age of 73.2 years ( sd14.3 , ranging from 48 to 95 years ) , with predilection for 
 females ( 66.7% ) . lesions showed leukoerythroplakic and ulcerated areas , respectively , in 
 78% and 56% of the cases , and tumors were mostly located on the alveolar mucosa / gingiva 
 ( 44.4% ) and buccal mucosa / buccal sulcus ( 33.3% ) . mean time of complaint was 24 months 
 ( sd41.9 , ranging from 1 to 120 months ) . size of the tumors showed a mean of 3.8 cm 
 ( sd1.3 , ranging from 2 to 5 cm ) , and most patients reported tobacco use ( 60% ) but not 
 alcohol use ( 66.7% ) . spindle cell carcinoma was diagnosed in 5 male adults ( mean age of 
 57 years , sd10.4 , ranging from 48 to 74 years ) . mean time of complaint was 6 months 
 ( sd5.3 , ranging from 2 to 12 months ) and ulcerated areas were found in 80% of the cases 
 while leukoerythroplakic areas were present in only 20% . the tumors affected the border 
 of tongue ( 40% ) , alveolar mucosa / gingiva ( 20% ) , soft palate ( 20% ) and other sites ( 20% ) . mean size of the tumors was 4.3 cm ( sd1.5 , ranging from 3 to 6 cm ) and the 5 patients 
 reported both tobacco and alcohol use . basaloid oscc affected the buccal mucosa of a 62 
 year - old male , with 123 months of evolution and an ulcerated and leukoerythroplakic 
 clinical aspect with 10 cm in size ; and the border of tongue of a 63 year - old female , 
 with 24 months of evolution and also with an ulcerated and leukoerythroplakic clinical 
 aspect with 2.5 cm in size . the papillary oscc 
 affected the buccal mucosa of a non - tobacco and non - alcohol user 64 year - old male as an 
 ulcerated lesion measuring 5 cm . although many studies have emphasized that oscc represent 80 to 90% of all oral 
 malignant tumors , the present study 
 has shown that about one third of all oral malignant tumors diagnosed in the oral 
 pathology laboratory , state university of rio de janeiro , were not oscc . as this service 
 is a local reference center for oral pathology in a metropolitan area , it is supposed 
 that the additional referral of more complex and challenging malignant cases can be 
 responsible for this bias in oscc frequency . oscc predominantly affects males with variable male : female ratios ranging in recent 
 studies from 6:1 to 2:1 , in accordance with the present results . several other recent studies have shown an increase in the number of affected females , 
 with a mean male : female ratio lower than 2:1 , probably due to changes in social and 
 daily activities associated to modern women social profile and way of living , leading to 
 higher exposure to carcinogenic agents , such as tobacco and alcohol consumption and 
 exposure to biological agents , such as high - risk hpv subtypes . most studies have reinforced that oscc is mostly diagnosed in adults with mean ages in 
 their fifties to seventies , a finding also corroborated by the present results . only 3% of the 
 patients reported in the present study were under 41 years of age , similarly to the 
 results presented by jainkittivong , et al . ( 2009 ) ( 4,7% ) and the means reported by the literature , usually 
 ranging from 4 to 6% . it seems that 
 there are geographical and populational differences in the mean age of the affected 
 patients , as demonstrated by effiom , et al . ( 2008 ) in nigeria , which revealed a mean age of 45.3 years - old and 
 40% of the patients with ages below 40 years - old . similarly to the results of the 
 present study , other authors have also demonstrated that the mean age of males affected 
 by oscc is lower than the mean age for females . present and past tobacco and alcohol consumption are considered the most important risk 
 factors for oscc . the present 
 results showed that both deleterious habits were frequently reported by oscc - affected 
 patients and that both were more common in males than in females , similarly to other 
 studies . this pattern 
 can be responsible for the differences in the male : female ratio of oscc - affected 
 patients . younger patients affected by oscc sometimes do not report tobacco and alcohol 
 use as possible risk factors or the interval of use is not long enough to support a 
 definite carcinogenic effect . other possible risk factors have been suggested in this 
 specific group , such as dietary / nutritional factors and genetic predisposition , and 
 high - risk hpv types ( especially hpv type 16 ) have been demonstrated in oscc in 
 youngsters more frequently than in control adult / elderly groups . oral potentially malignant disorders ( opmd ) are relatively common , showing a global 
 prevalence from 1 to 5% and a gender , age and site predilection similar to 
 oscc . although the exact 
 malignant transformation rate for opmd is unknown , it is expectable that 
 leukoerythroplakic areas can be encountered in association with oscc . this pattern was 
 found in 35% of the patients included in the present study . as the mean size of the 
 tumors , independent of affected gender , was lower than 4 cm ( ct1 and ct2 tumors ) and 
 more than two thirds of the patients complained of the lesions within less than 6 
 months , it is acceptable to consider that surveillance directed to opmd could have been 
 important in early diagnosis of oscc in the present population . additionally , these 
 results reinforce the importance of considering the possibility of oscc when dealing 
 with leukoplakias and erythroplakias , and the need of obtaining biopsy specimens from 
 all lesions from this group . oscc can affect any site of the oral mucosa and large lesions can invade several 
 continuous areas . the present results showed that the border of tongue , gingiva / alveolar 
 mucosa and floor of mouth / ventral tongue were the most commonly affected locations . although the border of tongue is considered the most common site for oscc in america and 
 europe , the buccal mucosa is the most common site for oscc in 
 southeastern asia , due to habits of areca nut- and tobacco - chewing . ( 2009 ) have additionally reported that 
 50% of their oscc affected the gingiva and alveolar ridge , which could be justified by 
 the different etiological factors associated with the development of oscc in their 
 specific population . ( 2008 ) have shown , in nigeria , that the lower and upper gingiva 
 were the most common affected sites in their sample , followed by the tongue . most 
 studies focusing on brazilian and other occidental populations have shown that the 
 border of tongue and floor of mouth are the most common oscc - affected regions . it is important to call attention to 
 the fact that , when considered together with intraoral locations , the lower lip is the 
 most common site for oscc . andisheh - tadbir , mehrabani and heydari ( 2008 ) have demonstrated that the tongue and the buccal mucosa were 
 the two most common locations for oscc in iran , and nemes , et al . ( 2008 ) have shown that , in hungary , the 
 floor of mouth , lips and the tongue were the most commonly affected areas . as 
 demonstrated by the present results , location of the tumors can be different when 
 comparing males ( border of tongue , floor of mouth / ventral tongue and gingiva / alveolar 
 mucosa ) and females ( border of tongue , gingiva / alveolar mucosa , buccal mucosa / buccal 
 sulcus ) . this gender - specific pattern was also reported by kruse , bredell and 
 grtz ( 2011 ) , who have 
 reported that females were more affected by oscc located on the palate and alveolar 
 mucosa . the exact reasons for this differential site predilection for oscc in males and 
 females are unknown . although delay in diagnosis is a major problem in early detection of oscc , the exact 
 reasons for these difficulties , including social and health - related behavior and tumor 
 characteristics , are not well - understood . most tumors included in the present series ( 76% ) were diagnosed as 
 ct1 or ct2 tumors , but mean interval of complaints prior to professional assistance was 
 10 months . ( 2001 ) , reviewing 740 oscc patients in the state of minas gerais , 
 also located in southeastern brazil , revealed that almost 50% of their patients with 
 oscc were diagnosed as t4 tumors . although this former study was published a decade ago 
 and it seems that tumors are being diagnosed in earlier stages in recent years , some 
 biases could justify these differences . the present study has presented data derived 
 from an oral pathology public service responsible for diagnosis of oscc mostly in 
 patients of low socioeconomic status . after diagnosis , these patients are referred to 
 public cancer treatment centers and some additional delay is expected , both due to 
 patient and institutional difficulties and limitations , before starting treatment . most oscc are histologically diagnosed as md or wd tumors , as was also shown by 
 the present results . ( 2008 ) have shown that 47.6% of their cases were histologically 
 classified as pd tumors , while wd tumors represented 32.6% of their sample . when 
 analyzing the present results , it was also observed that males were predominantly 
 affected by md and pd oscc , while females were mainly affected by wd and md tumors . it 
 was also shown that histological grade can also be possibly associated with the site of 
 the tumors , as oscc affecting the buccal mucosa / buccal sulcus and lower lip were 
 predominantly wd , while tumors affecting the border of tongue , floor of mouth / ventral 
 tongue and alveolar mucosa / gingiva were predominantly md , although the differences were 
 not statistically significant . several oscc variants have been reported in the literature and the establishment of the 
 specific appropriate histological diagnosis is essential , as some histological subtypes 
 and distinct clinicopathological entities are managed with different treatment protocols 
 and present variable prognosis . microinvasive oscc was diagnosed in 
 7.5% of the present cases and , in this specific pattern , careful evaluation of serial 
 sections and careful analysis of the basal lamina were performed in all cases , in order 
 to confirm early invasion and restriction of the tumor cells to the papillary lamina 
 propria . verrucous carcinoma was diagnosed in 9 cases ( 2.6% ) in the present sample and 
 the mean time of complaint was much longer than the mean time of complaint of the whole 
 sample , which can be justified by the indolent and painless course of this subtype . rekha and angadi ( 2010 ) have 
 recently reported a series of 133 verrucous carcinomas , representing 16% of all scc 
 diagnosed in their files from india . their cases have affected mostly males in their 
 fifties with predilection for the buccal mucosa . ( 2006 ) reported on 20 cases of verrucous 
 carcinoma from a brazilian population , reinforcing that elderly males were predominantly 
 affected with site predilection for the lower lip and hard palate . the present results 
 have shown that elderly females were the most affected group and that the tumors showed 
 a predilection for the alveolar mucosa / gingiva and buccal mucosa / buccal sulcus , but the 
 few cases included in the present series avoid any conclusive distinct pattern of 
 distribution of the disease in the studied population . although it has been reported in 
 a recent review that some studies 
 have named verrucous carcinomas with minor foci of invasion as " hybrid verrucous 
 carcinoma - wd oscc " , we have considered these " hybrid " tumors as wd oscc in the present 
 series . basaloid oscc is a rare aggressive variant with predilection for male adults , 
 usually tobacco and alcohol users , which is predominantly seen as an ulcerated exophytic 
 mass . both cases diagnosed in 
 the present series affected adults in their sixties and tumors were located on the 
 tongue and buccal mucosa . spindle cell carcinoma was diagnosed in 5 cases in the present 
 series and these cases have been comparatively evaluated elsewhere . the most representative limitations on the methods and results from the present study 
 are associated with the retrieval of clinical and histological information from , 
 respectively , laboratory records and incisional biopsies . on the other hand , the sample 
 represents the profile of oscc submitted to diagnosis in the studied population , 
 including both patients that are going to be submitted to curative and palliative oscc 
 treatment and patients who are not going to be submitted to any treatment due to 
 advanced disease . these data would properly reflect the epidemiological profile of oscc 
 in a public oral pathology diagnostic service in southeastern brazil . oscc age and gender profile , as well as site predilection , shows a heterogeneous pattern 
 of distribution in different countries , in different regions from the same country and 
 in different ethnic groups from the same region , which can be associated with both 
 genetic factors and cultural habits / behavior . studies focusing on specific regions are welcome as they show 
 the demographic and clinical profile of oscc in restricted geographic locations , 
 offering an enhanced comprehension of these tumors and the possibility of planning 
 specific strategies of prevention , diagnosis and treatment . demographic and clinical profile of oscc - affected patients in the studied population 
 revealed that females were affected about a decade older than males , that males reported 
 both tobacco and alcohol consumption more frequently than females and that the tumors in 
 males mostly affected the border of tongue , floor of mouth / ventral tongue and alveolar 
 mucosa / gingiva , while they were more frequent on the border of tongue , alveolar 
 mucosa / gingiva and buccal mucosa / buccal sulcus in females . ossc in males were 
 predominantly poorly and moderately differentiated tumors while they were mostly well 
 and moderately differentiated tumors in females . there were several differences when 
 comparing the clinicopathological data from oscc - affected male and female patients in 
 the studied population and other studies focusing on different brazilian and foreign 
 populations are encouraged to confirm these features .
epidemiological data from oral squamous cell carcinoma ( oscc ) is mostly derived from 
 north american , european and east asian populations.objectivethe aim of this study was to report the demographic and clinicopathological 
 features from oscc diagnosed in an oral pathology service in southeastern brazil 
 in an 8-year period.material and methodsall oscc diagnosed from 2005 to 2012 were reviewed , including histological 
 analysis of all hematoxylin and eosin stained slides and review of all demographic 
 and clinical information from the laboratory records.resultsa total of 346 oscc was retrieved and males represented 67% of the sample . 
 mean 
 age of the patients was 62.3 years - old and females were affected a decade older 
 than males ( p<0.001 ) . 
 mean time of complaint with the tumors was 10 months and 
 site distribution showed that the border of the tongue ( 37% ) , alveolar 
 mucosa / gingiva ( 20% ) and floor of mouth / ventral tongue ( 19% ) were the most common 
 affected sites . 
 mean size of the tumors was 3.4 cm , with no differences for males 
 and females ( p=0.091 ) and males reported both tobacco and alcohol consumption more 
 frequently than females . 
 histological grade of the tumors revealed that 27% , 40% 
 and 21% of the tumors were , respectively , classified as well- , moderately- and 
 poorly - differentiated oscc , 26 cases ( 7.5% ) were microinvasive oscc and 17 cases 
 were oscc variants . 
 oscc in males mostly affected the border of tongue , floor of 
 mouth / ventral tongue and alveolar mucosa / gingival , while they were more frequent 
 on the border of tongue , alveolar mucosa / gingival and buccal mucosa / buccal sulcus 
 in females ( p=0.004).conclusionsthe present data reflect the epidemiological characteristics of oscc diagnosed in 
 a public oral pathology laboratory in southeastern brazil and have highlighted 
 several differences in clinicopathological features when comparing male and female 
 oscc - affected patients .