Dismal outcome of oral squamous cell carcinoma after successful loco-regional control: Distant metastasis to rare sites

The main risk factors for distant metastasis (DM) from oral squamous cell carcinoma (OSCC) are poor loco-regional control, location, T and N stage and histologic grade of the primary tumor. In this paper we present three cases of DM from OSCC that occurred within the first year of treatment despite radical management of the primary lesion and without any evidence of loco-regional failure. These patients had stage IV lesions in different sites, one in the lip and two in the buccal mucosa with one extending into the alveolus. DM was seen to the lungs, vertebrae and contralateral axillary lymph node. Contralateral axillary node involvement is considered to be uncommon especially from lip carcinoma. After detection of DM all the three patients rapidly deteriorated and succumbed within an average period of 4 months.