- Email: [email protected]
MELANOACANTHOMA OF THE BUCCAL MUCOSA
ABSTRACTS
e76
MULTIPLE PRIMARY SQUAMOUS CELL CARCINOMAS OF THE LOWER LIP AND TONGUE: A CASE REPORT. INGRID DA SILVA SANTOS, VINICIUS COELHO CARRARD, MARCIA GAIGER DE OLIVEIRA, PANTELIS VARVAKI RADOS and, ISADORA LUANA FLORES Multiple primary oral squamous cell carcinomas (SCCs) are rare in clinical practice. A 62-year-old white male patient, a tobacco culture work farmer, was referred to our outpatient clinic for evaluation of a tongue lesion. A long-standing tobacco and alcohol consumption associated to daily occupational sun exposure was reported. The medical and family history was not contributory. Extraoral examination did not detect lymph nodes. The vermilion border of the lower lip had multiple crusted ulcerated lesions. Intraoral examination revealed an extensive endophytic ulcer with a yellowish surface affecting the right lateral border of the tongue with 4 months of evolution. Incisional biopsies were performed, and the histopathologic analyses confirmed the diagnosis of SCC for both lesions. The patient was referred for oncological therapy. This report shows the importance of the rigorous clinical examination performed by stomatologist for a complete diagnosis and adequate reference to treatment.
TREATMENT OF MYXOMA BY PARTIAL RESECTION AND IMMEDIATE RECONSTRUCTION WITH PARTICULATE AUTOGENOUS GRAFT WITH PLATELET-RICH FIBRIN. SOLIMAR DE OLIVEIRA PONTES, JULIANA MARIANO BERALDO, SERGIO LUCIO PEREIRA CASTRO LOPES, YASMIN ^ RODARTE CARVALHO, MONICA GHISLAINE OLIVEIRA ALVES, JANETE DIAS ALMEIDA and, FABIO RICARDO LOUREIRO SATO A 21-year-old man was referred to the oral medicine clinic for investigation of a mandibular lesion after orthodontic documentation. Extraoral examination revealed asymmetry with a volumetric increase of the mandibular angle on the left side. Intraorally, the mucosa was preserved with no expansion. Cone beam computed tomography (CBCT) revealed a well-circumscribed hypodense lesion, with anteroposterior growth involving the mandibular body in the region of teeth 37 and 38. Incisional biopsy was performed based on the diagnosis of odontogenic myxoma that was confirmed in the histopathologic examination. Partial mandibular resection through a Risdon access surgery was conducted under general anesthesia with the installation of mandibular reconstruction plate system of 2.4 mm and immediate reconstruction with a particulate graft of iliac crest associated with platelet-rich fibrin (PRF). The patient is in a follow-up of 6 months, and the last CBCT showed local bone formation.
ORAL LICHEN SCLEROSUS: A RARE CASE REPORT WITH EMPHASIS ON CLINICAL AND MORPHOLOGIC ASPECTS. RANI IANI COSTA GONCALO, ¸ HELLEN BANDEIRA DE PONTES SANTOS, YAILIT DEL CARMEN MARTINEZ VARGAS, HIANNE CRISTINNE DE MORAIS MEDEIROS, MARIANA CARVALHO XEREZ and, LELIA MARIA GUEDES QUEIROZ Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disease that often affects the anogenital area; oral mucosal
OOOO January 2020 lesions are extremely rare. A 52-year-old woman presented for evaluation of a persistent whitish plaque in the buccal mucosa with an 8-year evolution. Intraoral examination revealed multiple, elevated, whitish lesions diffusely distributed in the buccal mucosa associated with an area of tissue atrophy. Under the diagnostic hypothesis of leukoplakia or lichen planus, incisional biopsy was performed, obtaining the histopathologic diagnosis of oral LS. The patient was referred to the dermatologist and gynecologist for investigation of possible skin and genital lesions, respectively. Because of the time of evolution of the lesion, total surgical excision was performed, and the previous histopathologic diagnosis was confirmed. After 6 months of follow-up, there are no clinical signs of relapse. This case highlights the importance of clinical and histopathologic findings for the correct diagnosis and treatment of oral LS.
PLEOMORPHIC ADENOMA IN ADOLESCENT: A CASE OF DIFFICULT CONDUCT. TATIELLY KARINE COSTA ALVES, MARCELA CASTRO GOMES, TARCILIA APARECIDA DA SILVA, BELINI FREIRE MAIA, MARTINHO CAMPOLINA REBELLO HORTA and, SORAYA DE MATTOS CAMARGO GROSSMANN A 14-year-old male patient was referred to oral pathology with a lesion on the palate. His mother reported that the lesion was observed after the exodontia of 53. In the intraoral examination, a tumor with imprecise borders, mucosa-like coloration, and firm consistency located at the soft palate interface extending to vestibular gum near the teeth 16 and 17 was observed. Occlusal radiograph showed a poorly delimited radiolucent area without halo sclerotic halo in the hard palate region and right molar upper molars. An aspiration puncture was performed, which was negative for liquid. Incisional biopsy results were suggestive of salivary gland neoplasia. The patient was referred to the hospital where a tomographic examination was requested, the lesion was completely removed, and conclusive histopathologic diagnosis was determined. The histopathologic picture was conclusive of pleomorphic adenoma. The patient is undergoing surgery at our facility for a year with no signs of relapse.
MELANOACANTHOMA OF THE BUCCAL MUCOSA. PRISCILLA DINIZ, MAIRA TAVARES, JESSICA TAMIRES BORBA SILVA, ANA LUIZA ROZA, MICHELLE AGOSTINI, MARIO JOSE e ROMANACH and, BRUNO AUGUSTO BENEVENUTO DE ANDRADE Oral melanoacanthoma (MA) is a rare pigmented lesion characterized by hyperplasia of spinous keratinocytes and dendritic melanocytes that usually affects the buccal mucosa, lip, palate, and gingiva of adult women. An otherwise healthy 58year-old female patient presented a diffuse pigmented dark brown lesion on the right buccal mucosa measuring 5 cm in greatest diameter. The clinical differential diagnoses included melanocytic macule, melanocytic nevus, and melanoacanthoma. Gross features included a whitish soft tissue showing superficial pigmented deposits. The microscopic evaluation showed marked acanthosis of parakeratinized stratified squamous epithelium of the oral cavity, which was associated with heavily pigmented dendritic melanocytes in the basal and suprabasal layers of the epithelium. The lamina propria presented melanophages and
OOOO Volume 129, Number 1 lymphocytic infiltrate containing eosinophils. The biopsy site healed completely without complications. Oral clinicians and pathologists should consider oral melanoacanthoma in the clinical differential diagnosis of oral pigmented lesions.
SURGICAL MANAGEMENT OF A PATIENT WITH CROUZON SYNDROME CASE REPORT. VICTORIA LUSWARGHI SOUZA COSTA, HENRIQUE CABRINI MOREIRA and, FABIO RICARDO LOUREIRO SATO Crouzon syndrome is an autosomal dominant inheritance that affects the FGFR2 receptors, manifesting as craniosynostosis of the coronal and sagittal sutures. This clinical case reports the treatment of 47-year-old patient C.A.P. whose main complaint was related to obstructive sleep apnea. He reported other syndromic characteristics such as phonetic difficulty, respiratory and masticatory pain, bilateral pain in the temporomandibular joint, and headaches. Clinically, maxillary hypoplasia was observed, associated with exophthalmos and mandibular prognathism. The patient had a class III dentofacial deformity, also seen in lateral teleradiograph and panoramic radiograph. Polysomnography revealed moderate sleep apnea. The patient was surgically treated in 2 stages: distraction of the maxilla using an internal distracter device and, later, bimaxillary orthognathic surgery. New lateral and panoramic radiography and orthodontic finishing were performed. The patient reported obstructive sleep apnea resolution with improvement in masticatory, phonetic, and respiratory functions as well as facial harmonization with correction of gnathic bones.
ORTHODONTIC APPLIANCES AS TRIGGERS TO LICHEN SCLEROSUS. LETICIA SPINELLI JACOBY, MARIA EDUARDA LANES BALDINO, GABRIELA ALACARINI FARINA, RUCHIELLI LOUREIRO BORGHETTI, FERNANDA GONCALVES ¸ SALUM, KAREN CHERUBINI and, MARIA ANTONIA ZANCANARO DE FIGUEIREDO Lichen sclerosus (LS) is a rare mucocutaneous disease and has autoimmune characteristics. The etiology is unknown. Local factors, such as trauma, can play a role. Women are more affected than men, especially during prepubertal and postmenopausal periods. Genital manifestations are the most common. Oral lesions are rare. A 12-year-old patient and a 14-year-old patient complained about asymptomatic white plaques on the upper lip with 2 and 12 months of evolution, respectively, that appeared after bonding of orthodontic appliances. Physical examination showed porcelain-white flat lesions on the upper lip, labial mucosa, and gingiva. Laboratory examinations were performed with no significant changes. Panoramic radiograph showed bone loss in the maxillary right central and lateral incisors of the 12-year-old patient. Cone beam computed tomography showed bone loss and root fenestration in the maxillary left central incisor of the 14-year-old patient. Incisional biopsies under local anesthesia were performed. Microscopic examination confirmed the clinical diagnosis of LS.
DOUBLE NON-HODGKINS LYMPHOMA IN A RENAL TRANSPLANT PATIENT. GABRIELA ALACARINI FARINA, DIENI DA SILVEIRA TEIXEIRA, GABRIEL CAMPOS LOUZEIRO, RUCHIELLI
ABSTRACTS
e77
LOUREIRO BORGHETTI, KAREN CHERUBINI, FERNANDA GONCALVES ¸ SALUM and, MARIA ANTONIA ZANCANARO DE FIGUEIREDO A 63-year-old white female patient who underwent renal transplant was referred by the oral surgeon to the oral medicine unit. She complained of discomfort on the left maxilla evolving for 3 months. She was taking mycophenolate mofetil prescribed by the nephrologist. As a previous treatment of the lesion, tooth 24 was treated endodontically, but no improvement was noted. Intraoral physical examination showed yellowish ulcerated lesion of firm consistency on the hard palate (region 23 to 26) with superficial necrosis. The presence of a submucosal nodule in the vestibule (region 43 to 45) was also observed. Clinically, the palatine lesion was compatible with neoplasia and the submucosal nodule with salivary retention cyst. Imaging and preoperative examinations were requested for posterior incisional biopsy of the 2 lesions. Histopathologic diagnosis (hematoxylin and eosin and immunohistochemistry) was double non-Hodgkins lymphoma. She was referred for treatment at the oncology department.
ANGIOLEIOMYOMA OF THE ORAL CAVITY: REPORT OF 4 NEW CASES. THAMYRES CAMPOS FONSECA, THAMIRIS DE CASTRO e MARCIA GRILLO CABRAL, ABRANTES, ELAINE LEITAO, BRUNO AUGUSTO BENEVENUTO DE ANDRADE, e ^A MARIO JOSE ROMANACH and, ALINE CORRE e ABRAHAO Angioleiomyoma (ALM) is a benign smooth muscle tumor that occasionally affects the oral cavity, mainly the lips and hard palate of adults. We report the clinicopathologic features of 4 new cases of oral ALM. There were 2 women and 2 men with mean age of 54 years (range, 34 73 years). The clinical presentation of tumors was asymptomatic, slow-growing small nodules with color varying from normal to bluish, affecting the lower lip, hard palate, lingual frenulum, and maxillary fold. Microscopically, proliferation of fascicles of smooth muscle cells with pale, eosinophilic, and vacuolated cytoplasm and elongated nuclei were observed in a whorled pattern around a central endothelium-lined space. All patients were submitted to conservative surgical removal, and no signs of recurrence were observed. Oral ALM is uncommon and should be considered in the clinical differential diagnosis of solitary dome-shaped nodules of the oral cavity.
CARCINOMA CUNICULATUM OF THE ALVEOLAR RIDGE. THAMYRES CAMPOS FONSECA, THAMIRIS DE CASTRO ABRANTES, MARCIA GRILLO CABRAL, MARIO JOSE e ROMANACH, MICHELLE AGOSTINI, BRUNO AUGUSTO BENEVENUTO DE ANDRADE and, ALINE e ^ A ABRAHAO CORRE Carcinoma cuniculatum (CC) is a rare, well-differentiated variant of oral squamous cell carcinoma that usually affects the mucoperiosteum of older patients. Oral CC appears mainly as locally destructive tumors with superficial drainage of keratin, with low risk of metastasis. A 56-year-old white woman, a nonsmoker and nondrinker, presented a nonhealing gingival ulcer with duration of 2 months. Intraoral examination showed a welldefined irregular ulcer in the posterior upper alveolar ridge with drainage of a whitish material suggestive of keratin during palpation. Periapical radiograph showed an ill-defined osteolytic
e76
MULTIPLE PRIMARY SQUAMOUS CELL CARCINOMAS OF THE LOWER LIP AND TONGUE: A CASE REPORT. INGRID DA SILVA SANTOS, VINICIUS COELHO CARRARD, MARCIA GAIGER DE OLIVEIRA, PANTELIS VARVAKI RADOS and, ISADORA LUANA FLORES Multiple primary oral squamous cell carcinomas (SCCs) are rare in clinical practice. A 62-year-old white male patient, a tobacco culture work farmer, was referred to our outpatient clinic for evaluation of a tongue lesion. A long-standing tobacco and alcohol consumption associated to daily occupational sun exposure was reported. The medical and family history was not contributory. Extraoral examination did not detect lymph nodes. The vermilion border of the lower lip had multiple crusted ulcerated lesions. Intraoral examination revealed an extensive endophytic ulcer with a yellowish surface affecting the right lateral border of the tongue with 4 months of evolution. Incisional biopsies were performed, and the histopathologic analyses confirmed the diagnosis of SCC for both lesions. The patient was referred for oncological therapy. This report shows the importance of the rigorous clinical examination performed by stomatologist for a complete diagnosis and adequate reference to treatment.
TREATMENT OF MYXOMA BY PARTIAL RESECTION AND IMMEDIATE RECONSTRUCTION WITH PARTICULATE AUTOGENOUS GRAFT WITH PLATELET-RICH FIBRIN. SOLIMAR DE OLIVEIRA PONTES, JULIANA MARIANO BERALDO, SERGIO LUCIO PEREIRA CASTRO LOPES, YASMIN ^ RODARTE CARVALHO, MONICA GHISLAINE OLIVEIRA ALVES, JANETE DIAS ALMEIDA and, FABIO RICARDO LOUREIRO SATO A 21-year-old man was referred to the oral medicine clinic for investigation of a mandibular lesion after orthodontic documentation. Extraoral examination revealed asymmetry with a volumetric increase of the mandibular angle on the left side. Intraorally, the mucosa was preserved with no expansion. Cone beam computed tomography (CBCT) revealed a well-circumscribed hypodense lesion, with anteroposterior growth involving the mandibular body in the region of teeth 37 and 38. Incisional biopsy was performed based on the diagnosis of odontogenic myxoma that was confirmed in the histopathologic examination. Partial mandibular resection through a Risdon access surgery was conducted under general anesthesia with the installation of mandibular reconstruction plate system of 2.4 mm and immediate reconstruction with a particulate graft of iliac crest associated with platelet-rich fibrin (PRF). The patient is in a follow-up of 6 months, and the last CBCT showed local bone formation.
ORAL LICHEN SCLEROSUS: A RARE CASE REPORT WITH EMPHASIS ON CLINICAL AND MORPHOLOGIC ASPECTS. RANI IANI COSTA GONCALO, ¸ HELLEN BANDEIRA DE PONTES SANTOS, YAILIT DEL CARMEN MARTINEZ VARGAS, HIANNE CRISTINNE DE MORAIS MEDEIROS, MARIANA CARVALHO XEREZ and, LELIA MARIA GUEDES QUEIROZ Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disease that often affects the anogenital area; oral mucosal
OOOO January 2020 lesions are extremely rare. A 52-year-old woman presented for evaluation of a persistent whitish plaque in the buccal mucosa with an 8-year evolution. Intraoral examination revealed multiple, elevated, whitish lesions diffusely distributed in the buccal mucosa associated with an area of tissue atrophy. Under the diagnostic hypothesis of leukoplakia or lichen planus, incisional biopsy was performed, obtaining the histopathologic diagnosis of oral LS. The patient was referred to the dermatologist and gynecologist for investigation of possible skin and genital lesions, respectively. Because of the time of evolution of the lesion, total surgical excision was performed, and the previous histopathologic diagnosis was confirmed. After 6 months of follow-up, there are no clinical signs of relapse. This case highlights the importance of clinical and histopathologic findings for the correct diagnosis and treatment of oral LS.
PLEOMORPHIC ADENOMA IN ADOLESCENT: A CASE OF DIFFICULT CONDUCT. TATIELLY KARINE COSTA ALVES, MARCELA CASTRO GOMES, TARCILIA APARECIDA DA SILVA, BELINI FREIRE MAIA, MARTINHO CAMPOLINA REBELLO HORTA and, SORAYA DE MATTOS CAMARGO GROSSMANN A 14-year-old male patient was referred to oral pathology with a lesion on the palate. His mother reported that the lesion was observed after the exodontia of 53. In the intraoral examination, a tumor with imprecise borders, mucosa-like coloration, and firm consistency located at the soft palate interface extending to vestibular gum near the teeth 16 and 17 was observed. Occlusal radiograph showed a poorly delimited radiolucent area without halo sclerotic halo in the hard palate region and right molar upper molars. An aspiration puncture was performed, which was negative for liquid. Incisional biopsy results were suggestive of salivary gland neoplasia. The patient was referred to the hospital where a tomographic examination was requested, the lesion was completely removed, and conclusive histopathologic diagnosis was determined. The histopathologic picture was conclusive of pleomorphic adenoma. The patient is undergoing surgery at our facility for a year with no signs of relapse.
MELANOACANTHOMA OF THE BUCCAL MUCOSA. PRISCILLA DINIZ, MAIRA TAVARES, JESSICA TAMIRES BORBA SILVA, ANA LUIZA ROZA, MICHELLE AGOSTINI, MARIO JOSE e ROMANACH and, BRUNO AUGUSTO BENEVENUTO DE ANDRADE Oral melanoacanthoma (MA) is a rare pigmented lesion characterized by hyperplasia of spinous keratinocytes and dendritic melanocytes that usually affects the buccal mucosa, lip, palate, and gingiva of adult women. An otherwise healthy 58year-old female patient presented a diffuse pigmented dark brown lesion on the right buccal mucosa measuring 5 cm in greatest diameter. The clinical differential diagnoses included melanocytic macule, melanocytic nevus, and melanoacanthoma. Gross features included a whitish soft tissue showing superficial pigmented deposits. The microscopic evaluation showed marked acanthosis of parakeratinized stratified squamous epithelium of the oral cavity, which was associated with heavily pigmented dendritic melanocytes in the basal and suprabasal layers of the epithelium. The lamina propria presented melanophages and
OOOO Volume 129, Number 1 lymphocytic infiltrate containing eosinophils. The biopsy site healed completely without complications. Oral clinicians and pathologists should consider oral melanoacanthoma in the clinical differential diagnosis of oral pigmented lesions.
SURGICAL MANAGEMENT OF A PATIENT WITH CROUZON SYNDROME CASE REPORT. VICTORIA LUSWARGHI SOUZA COSTA, HENRIQUE CABRINI MOREIRA and, FABIO RICARDO LOUREIRO SATO Crouzon syndrome is an autosomal dominant inheritance that affects the FGFR2 receptors, manifesting as craniosynostosis of the coronal and sagittal sutures. This clinical case reports the treatment of 47-year-old patient C.A.P. whose main complaint was related to obstructive sleep apnea. He reported other syndromic characteristics such as phonetic difficulty, respiratory and masticatory pain, bilateral pain in the temporomandibular joint, and headaches. Clinically, maxillary hypoplasia was observed, associated with exophthalmos and mandibular prognathism. The patient had a class III dentofacial deformity, also seen in lateral teleradiograph and panoramic radiograph. Polysomnography revealed moderate sleep apnea. The patient was surgically treated in 2 stages: distraction of the maxilla using an internal distracter device and, later, bimaxillary orthognathic surgery. New lateral and panoramic radiography and orthodontic finishing were performed. The patient reported obstructive sleep apnea resolution with improvement in masticatory, phonetic, and respiratory functions as well as facial harmonization with correction of gnathic bones.
ORTHODONTIC APPLIANCES AS TRIGGERS TO LICHEN SCLEROSUS. LETICIA SPINELLI JACOBY, MARIA EDUARDA LANES BALDINO, GABRIELA ALACARINI FARINA, RUCHIELLI LOUREIRO BORGHETTI, FERNANDA GONCALVES ¸ SALUM, KAREN CHERUBINI and, MARIA ANTONIA ZANCANARO DE FIGUEIREDO Lichen sclerosus (LS) is a rare mucocutaneous disease and has autoimmune characteristics. The etiology is unknown. Local factors, such as trauma, can play a role. Women are more affected than men, especially during prepubertal and postmenopausal periods. Genital manifestations are the most common. Oral lesions are rare. A 12-year-old patient and a 14-year-old patient complained about asymptomatic white plaques on the upper lip with 2 and 12 months of evolution, respectively, that appeared after bonding of orthodontic appliances. Physical examination showed porcelain-white flat lesions on the upper lip, labial mucosa, and gingiva. Laboratory examinations were performed with no significant changes. Panoramic radiograph showed bone loss in the maxillary right central and lateral incisors of the 12-year-old patient. Cone beam computed tomography showed bone loss and root fenestration in the maxillary left central incisor of the 14-year-old patient. Incisional biopsies under local anesthesia were performed. Microscopic examination confirmed the clinical diagnosis of LS.
DOUBLE NON-HODGKINS LYMPHOMA IN A RENAL TRANSPLANT PATIENT. GABRIELA ALACARINI FARINA, DIENI DA SILVEIRA TEIXEIRA, GABRIEL CAMPOS LOUZEIRO, RUCHIELLI
ABSTRACTS
e77
LOUREIRO BORGHETTI, KAREN CHERUBINI, FERNANDA GONCALVES ¸ SALUM and, MARIA ANTONIA ZANCANARO DE FIGUEIREDO A 63-year-old white female patient who underwent renal transplant was referred by the oral surgeon to the oral medicine unit. She complained of discomfort on the left maxilla evolving for 3 months. She was taking mycophenolate mofetil prescribed by the nephrologist. As a previous treatment of the lesion, tooth 24 was treated endodontically, but no improvement was noted. Intraoral physical examination showed yellowish ulcerated lesion of firm consistency on the hard palate (region 23 to 26) with superficial necrosis. The presence of a submucosal nodule in the vestibule (region 43 to 45) was also observed. Clinically, the palatine lesion was compatible with neoplasia and the submucosal nodule with salivary retention cyst. Imaging and preoperative examinations were requested for posterior incisional biopsy of the 2 lesions. Histopathologic diagnosis (hematoxylin and eosin and immunohistochemistry) was double non-Hodgkins lymphoma. She was referred for treatment at the oncology department.
ANGIOLEIOMYOMA OF THE ORAL CAVITY: REPORT OF 4 NEW CASES. THAMYRES CAMPOS FONSECA, THAMIRIS DE CASTRO e MARCIA GRILLO CABRAL, ABRANTES, ELAINE LEITAO, BRUNO AUGUSTO BENEVENUTO DE ANDRADE, e ^A MARIO JOSE ROMANACH and, ALINE CORRE e ABRAHAO Angioleiomyoma (ALM) is a benign smooth muscle tumor that occasionally affects the oral cavity, mainly the lips and hard palate of adults. We report the clinicopathologic features of 4 new cases of oral ALM. There were 2 women and 2 men with mean age of 54 years (range, 34 73 years). The clinical presentation of tumors was asymptomatic, slow-growing small nodules with color varying from normal to bluish, affecting the lower lip, hard palate, lingual frenulum, and maxillary fold. Microscopically, proliferation of fascicles of smooth muscle cells with pale, eosinophilic, and vacuolated cytoplasm and elongated nuclei were observed in a whorled pattern around a central endothelium-lined space. All patients were submitted to conservative surgical removal, and no signs of recurrence were observed. Oral ALM is uncommon and should be considered in the clinical differential diagnosis of solitary dome-shaped nodules of the oral cavity.
CARCINOMA CUNICULATUM OF THE ALVEOLAR RIDGE. THAMYRES CAMPOS FONSECA, THAMIRIS DE CASTRO ABRANTES, MARCIA GRILLO CABRAL, MARIO JOSE e ROMANACH, MICHELLE AGOSTINI, BRUNO AUGUSTO BENEVENUTO DE ANDRADE and, ALINE e ^ A ABRAHAO CORRE Carcinoma cuniculatum (CC) is a rare, well-differentiated variant of oral squamous cell carcinoma that usually affects the mucoperiosteum of older patients. Oral CC appears mainly as locally destructive tumors with superficial drainage of keratin, with low risk of metastasis. A 56-year-old white woman, a nonsmoker and nondrinker, presented a nonhealing gingival ulcer with duration of 2 months. Intraoral examination showed a welldefined irregular ulcer in the posterior upper alveolar ridge with drainage of a whitish material suggestive of keratin during palpation. Periapical radiograph showed an ill-defined osteolytic