Beyond the usual suspects: Oral squamous cell carcinoma in non-alcoholic and non-tobacco users - a case series

Oral squamous cell carcinoma (OSCC) is traditionally linked to well-established carcinogenic factors such as tobacco and alcohol use. However, an increasing number of cases have been reported in individuals without these conventional risk exposures. This case series presents three clinically and histopathologically confirmed OSCC cases in patients who denied any history of tobacco or alcohol consumption. All patients presented with non-healing oral lesions that mimicked benign or inflammatory conditions, leading to diagnostic delays. Common sites included the gingiva and alveolar ridge, regions not typically associated with OSCC in habitual users. Histological evaluation revealed moderately to well-differentiated squamous cell carcinoma with keratin pearl formation and connective tissue invasion. Two of the patients were diabetic, suggesting a potential role of systemic comorbidities in disease development. These cases emphasize the need for heightened clinical vigilance and early biopsy of persistent oral lesions, even in the absence of traditional risk factors. A broader understanding of OSCC etiology beyond tobacco and alcohol is essential for timely diagnosis and improved patient outcomes.