Massive, Fungating Squamous Cell Carcinoma of Buccal Mucosa in Middle-aged Male

DESCRIPTION A 48-year-old male patient reported to the tertiary care cancer center at this stage with fungating, cauliflower-like mass [Figure 1]. In this case, the patient was habituated with chewing kharras containing betel nut, lime, and tobacco for the last 16 years. He used to eat such kharras about 6–8 times a day. He used to keep that kharras containing tobacco quid in between the cheek and lower gums. Initially, the ulcer developed over the inner buccal mucosa, reddish oval in shape with decreased mouth opening. The ulcer kept growing and became painful. It infiltrated and indurated the buccal mucosa and skin and got fungated which rapidly progressed to its current size in 2–3 months and became of size approximately 10 cm × 8.5 cm, reddish pink in color with everted margins and indurated, firm to hard with some friable material in the center of ulcer. He was admitted and investigations included biopsy, hemogram, and computed tomography of oral cavity, neck, and chest. The biopsy was suggestive of well-developed squamous cell carcinoma with clinical stage of T4N2M1 with lung metastasis. The treatment included palliative chemotherapy with paclitaxel, cisplatin, and 5-fluorouracil weekly for 6 cycles. He responded well symptomatically. However, patient could not be subjected to definitive surgery or radiotherapy due to extensive regional involvement. Most of the time, oral cancer cases are reporting in stage 3 and stage 4 to the tertiary care hospital, and late-stage reporting is a global problem.[1] Addiction to tobacco in any form of Indian products such as khaini, kharra, ghutka, snuff, bidi, cigarettes, hukkah, and betel-quid (Paan) is exposing the younger Indians to such serious conditions. Indian oral cancers are related to tobacco addiction and consumption of high quantities of spices.[2] However, Western oral cancers are usually related to oral human papillomavirus infection.[3] Treatment options for such locally advanced disease are induction chemotherapy to downsize and downstage the lesion, and then to be operated with radical surgery, if deemed to be operable and subsequent adjuvant radiation and concurrent chemotherapy.Figure 1: Extraoral fungating mass of oral squamous cell carcinomaLEARNING POINTS/TAKE-HOME MESSAGES Public awareness and referral mechanisms for early diagnosis and treatment are essential Definitive curative treatment can be provided with early reporting of cases to tertiary-level cancer hospitals. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflict of interest There are no conflicts of interest.