An Atypical Presentation of Diffuse Basaloid Human Papillomavirus (HPV)-Related Squamous Cell Carcinoma of the Oral Cavity in the Setting of Prior Radiation

Basaloid squamous cell carcinoma (BSCC) is a rare subtype of squamous cell carcinoma (SCC) that can occur in the head and neck region. This particularly aggressive type of SCC has been linked to human papillomavirus (HPV) and carries a better prognosis when found in the oropharynx. We present a rare manifestation of oropharyngeal basaloid HPV-related SCC in a 75-year-old female with a history of prior radiation to the head and neck area for moderately differentiated SCC of the epiglottis. The patient presented with an erythematous rash-like mucosal lesion that extended from the oral vestibule and mucosa of the lower lip to the right buccal trigone, without any mass lesions. The case presented here is unique due to the presence of oral HPV-related BSCC in the setting of a past medical history of prior head and neck radiation. The nature of this lesion can result in late-stage diagnosis and poor patient outcomes. The uncharacteristic presentation seen in this patient emphasizes the importance of early diagnosis and management. Awareness of a variety of presentations of this aggressive cancer type is warranted due to the poor prognosis this variant carries, especially when diagnosed in advanced stages.