Tobacco As a Trigger for Oral Squamous Cell Carcinoma Arising in The Background of Oral Submucous Fibrosis: A Clinicopathological Study

Background: Oral submucous fibrosis (OSMF) is a well-recognized, potentially malignant disorder of the oral cavity that can affect any part of the oral mucosa, characterized by mucosal rigidity of varying intensity caused by fibro elastic transformation of the juxta-epithelial layer of connective tissue. The habit of betel quid chewing and the usage of tobacco is a popular oral habit with potential links to the development of oral cancer. The oral epithelium in patients with oral submucous fibrosis becomes atrophic and progresses to a clinicopathologically different entity of oral squamous cell carcinoma.Aim: The aim of the present study is to analyze the common clinical and histopathological features in the cases of OSCC arising in the background of OSMF.Materials and Methods: A total of five cases reported between May 2019 and May 2021 which were histopathologically diagnosed as oral squamous cell carcinoma with oral submucous fibrosis were selected and the most common clinical and histpathological features were analysed. Immunohistochemical analysis was done using SMA, E-Cadherin and MMP-9 markers.Results: Smokeless tobacco usage was the most commonly used form of tobacco in these patients. Facial asymmetry, blanching and palpable fibrotic bands were the most common clinical features noted among these patients. Broad bulbous rete ridges was the most common histopathological feature associated with this entity. Positive expression of E-cadherin and SMA markers were noted. Conclusion: OSCC arising from the background of OSMF can be considered as a separate entity.More molecular studies are needed to assess the etiopathogenesis and whether treatment for OSMF has an effect on pathogenesis of this OSCC-OSMF entity.