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Objectives: The incidence of oral malignancy presenting in the gingiva is very low. Gingival squamous cell carcinoma can appear similar to a variety of gingival lesions ranging from benign reactive inflammatory lesions to less common malignancies. Misdiagnosis often leads to delayed management of the disease that affects the patient’s prognosis and survival rate. This case report describes a case of gingival squamous cell carcinoma of the mandibular incisors presenting clinically as reactive pyogenic granuloma.
Methods: A 46-year-old female was referred to the Periodontal Specialist Clinic in 2019 with a complaint of recurrent gum swelling in the lower front teeth region, which she claimed occurred after a small piece of apple got stuck between her teeth. The swelling was painless, however, she felt discomfort. Based on the clinically benign-looking lesion, a differential diagnosis of pyogenic granuloma, fibrous epulis, and other benign reactive/inflammatory lesions was made. An excisional biopsy was performed under local anaesthesia.
Results: The histological examination revealed severely dysplastic stratified squamous epithelium invading into the underlying connective tissue. The final diagnosis is a well-differentiated squamous cell carcinoma of the gingiva (T1N0M0).
Conclusions: The important role of dental practitioners in the early detection of gingival malignancy, especially for those practising in periodontal specialist settings, can significantly improve patient survival. This case report demonstrates the need to biopsy all suspicious gingival lesions for histopathological examination.
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