Suspect oral squamous cell carcinoma in an elderly patient with betel-quid chewing history: A case report

Introduction: Betel-quid chewing is habitually practiced in parts of Indonesia and comprises of various composition. It is a well-established risk factor of numerous oral mucosal lesions, including oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma. The present study aimed to discuss a case of suspected oral squamous cell carcinoma in an elderly patient with betel-quid chewing as a risk factor. Case report: A 76-year-old female presented to the dental hospital of Universitas Indonesia; she was referred from a private hospital with a working diagnosis of pseudomembranous candidiasis on the left buccal mucosa. She had chewed betel-quid, a mixture of betel-quid leaf, lime, areca nut, gambier, and tobacco, for more than 20 years. An intra-oral examination revealed mixed white nodular and plaque lesions on the left buccal and alveolar mucosa, an erythematous base, ulceration and induration in posterior part of the lesion adjacent to the retromolar pad, which led to the clinical suspicion of oral squamous cell carcinoma. Betel-quid chewing is believed to be a risk factor of oral squamous cell carcinoma. The betel-quid composition, long duration and moderately high frequency of chewing, the way betel-quid is kept in the mouth, increased patient's age, and poor oral hygiene increase the risk of oral squamous cell carcinoma. Conclusion: As dentists, we play a key role in the early detection of oral mucosal changes associated with betel-quid chewing, particularly OPMDs and oral squamous cell carcinoma, and to provide adequate education and treatment for the patients.