Field canceristion of the oral cavity secondary to tobacco abuse could be the reason you. Could read the monogram on oral cancers in OCNA

Thank you srinivas for your response.. one point which i could not digest in our case is, the patient had recurrence not at the same site, but little away, that too the disease has never been aggressive..

Dear Vadish,

The cancerization field is one of the topics argued for development of multiple SCCs or secondary primary tumors (SPTS) within the oral cavity and oropharynx, even far away from the site of primary tumor. Also, the presence of human papilloma virus (HPV) and the administration of post-op radiotherapy could be reasons for the appearance of recurrences. I would suggest you reading my paper concerning recurrences of oral SCC in a series of 500 patients: "Local recurrences and second primary tumors from squamous cell carcinoma of the oral cavity. A retrospective analytic study of 500 patients", published in Head and Neck in 2009 in which we concluded that: The identification of preoperative and postoperative clinical and pathological features that prelude a higher risk for the appearance of LRs and/or SPTs may be of potential interest in determining which patients should benefit of a closer

regular follow-up, and also that when considering together the whole clinical and pathological features, only postoperative RT and bone involvement were predictive for the development of LRs. Because of the poor survival rate of the affected patients, we strongly recommend aggressive surgical treatment following

the appearance of an SPT or LR.

Thank you Raul for the response..

Metastasis! Where was the primary tumour located?

Dear Jose Tavares, thank you for your response.. Frankly I do not feel these as metastases. because he s a smoker, getting an oral malignacy is known in his situation. in the first presentation, he had a small lesion, which could be comfortably excised. For subsequent lesion he underwent hemimandibulectomy, and the trird recurrence was again a very small lesion.. but the fourth one, is wuite large, as this lesion is developing after 5 years of initial diagnosis.. so I feel, its the primary disease only.. moreover metastasis to oral cavity is quite rare.. thank you

Unfortunately this is all too common a problem. While positive margins is undoubtedly a major risk factor for LR and death, we commonly see cancers which recur despite widely negative margins and N0 necks. How the specimen is processed and assessed by the Pathologist is undoubtedly important. In-tranit metastases, local lymphovascular spread, tumour implantation during resection, and field cancerization are all possibilities

Field cancerization could be an important factor, however, this concept is commonly used to mean both, colonized tissue and sensitized tissue, it is very possible that the margins were completely free of neoplastic tissue but is possible that the surrounding normal stroma was prone to develop into the same kind of cancer or there were disseminated cancer cells in a latent state in the same organ but they jus were hidden in normal tissue.

Thank you for your inputs. Meanwhile we had one more unfortunate female who presented with an ulcer of less than one cm on the lateral border of tongue. she underwent wide excision with adequate margin and neck dissection. as the neck dissection had one positive node, she was irradiated with 60Gy, still she presented with a similar ulcer on the other border after 6 months. this was again dealt with surgery, with negative margin. unfortunately she had a recurrence on the base of tongue again within 6 months. she was non smoker.