Module 5
Oral Cancer
Examination
Oral Cancer Exam
 To properly perform
an oral cancer
examination, you
will need:
– a good light source
– mouth mirror
– gloves
– gauze
– tongue depressor
Extraoral exam:
Visually
assess the
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head
face
eyes
ears
neck
Second Step:
Palpate Lymph Nodes
Look for
changes in:
 Size
 Mobility
 Consistency
Lymph nodes to palpate include the:
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Preauricular
Postauricular
Submandibular
Anterior &
posterior cervical
 Occipital
 Supraclavicular
 Parotid salivary
gland
Preauricular & Parotid Gland
Postauricular
Submandibular & Submental
Anterior Cervical
Posterior Cervical
Occipital
Supraclavicular
Intraoral Exam
Visually and digitally assess the:
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Lips
Labial mucosa
Buccal mucosa
Gingiva
Tongue
Floor of the mouth
Palate
Changes to observe include:
 absence of symmetry
 enlargements
 swellings
 dry or crusty areas
 lesions
 color changes
Lips
Assess:
Color
Texture
Presence of
lesions on the
upper and lower
vermilion borders
Lips
 Bidigitally
palpate the
lower lip from
one commissure
to the other for
any changes in
texture or
swellings.
Use the same technique for the upper lip.
Labial Mucosa
Assess by pulling the
upper and lower lip
away from the teeth
to observe the labial
mucosa and frena for
changes in:
color
texture
swelling
Maxillary Labial Mucosa
Mandibular Labial Mucosa
Buccal mucosa
Retract with a finger, mirror or tongue depressor.
Look for
changes in:
 color
 texture
 mobility
 swelling
 lesions
Buccal Mucosa - Bidigital Palpation
Repeat procedure on the other side of the mouth.
Begin with facial
gingiva and
alveolar ridges in
the maxillary right
posterior gingiva.
Follow the arch
around to the left
side.
Drop to the lower
left and follow
around to the
lower right
Gingiva
Tongue
Observe the dorsum
of the tongue for:
swelling
ulceration
coating
changes in
papillae
pattern
variations in
-size
-color
-texture
Tongue
Grasp the tip
of the tongue
with a piece
of gauze and
gently pull out
and to the
side to allow
complete
observation
Repeat on the other side.
Examine the ventral surface
 Ask the patient to
place the tip of
the tongue on
the palate to
observe the
ventral surface.
 Palpate the
tongue to feel for
any growths.
Floor of the mouth
With the
tongue still
raised:
Inspect the
floor of the
mouth
Floor of the mouth
Look for
changes in:
color
texture
swellings
ulcerations
Floor of the mouth
 Bimanually palpate
the sublingual area
 Place the index
finger of one hand
inside the mouth
 Place the fingertips
of the other hand
extraorally under the
chin
Palate
With the
patient’s head
tilted back:
observe the
hard
and
soft palate
Oropharynx
Visually
assess the
oropharynx
Anatomical Landmarks
 The next several slides will show
normal anatomical features present in
the oral cavity, as well as some
common features that are innocuous
or self-limiting.
Gingiva
Vestibule
Buccal Mucosa
Oropharynx
Dorsum of the tongue
Floor of the mouth
Palate
Features that represent deviations
from normal that are observed on
the tongue include:
Scalloped edges
Fissured tongue
Median rhomboid glossitis
Geographic tongue (erythema migrans)
Hairy tongue
Fissured tongue
Used with permission from John L. Giunta, BS, DMD, MS http://www.forsyth.org/oralpathology/case_014.htm
Median rhomboid glossitis
Used with permission from John L. Giunta, BS, DMD, MS http://www.forsyth.org/oralpathology/case_051.htm
Geographic tongue
Used with permission from John L. Giunta, BS, DMD, MS http://www.forsyth.org/oralpathology/case_013.htm
Hairy tongue
Used with permission from John L. Giunta, BS, DMD, MS http://www.forsyth.org/oralpathology/case_057.htm
Mandibular Tori & Palatal Torus
Used with permission from John L. Giunta, BS, DMD, MS
http://www.forsyth.org/oralpathology/case_044.htm
Lips
Herpetic lesions
Lips
Angular cheilitis
Lips
Actinic cheilitis
Buccal mucosa
Linea alba
Labial mucosa
Aphthous ulcers
Buccal mucosa
Fordyce granules
Summary
 Performing an oral cancer examination
involves a visual and tactile assessment of
head and neck.
 The extraoral examination includes the
face, neck, head, eyes, and ears.
 Lymph nodes are palpated for masses and
consistency.
The intraoral examination
includes inspecting and
palpating the:
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Lips
Labial mucosa
Buccal mucosa
Gingiva
Tongue
Floor of the mouth
Palate
If you find a lesion . . .
• If oral cancer is strongly suspected,
refer immediately for biopsy.
• Reevaluate lesion in 14 days. If the lesion has
not resolved after that length of time, measures
should be taken, including a referral to a
specialist for biopsy.
• Use of the screening aids that are currently
available may also be performed to assist in
evaluating lesions.
The most important takehome message is:
 Perform an oral cancer examination
on all of your patients!
 It takes very little time and may save
a life!