Sir, I am concerned about a new group of patients I have been seeing in my practice recently. There is a growing number of patients who have developed oral cancer in innocuous-looking lesions in the oral cavity. There is no tobacco/betelnut/paan habit or traumatic, sharp teeth present, and these are young patients, between 20 and 30 years of age.

One such patient was only 19-years-old when she came to me with a tongue ulcer. The chief complaint of the patient was about a small painless ulcer on the side of the tongue which had not prompted her to seek treatment initially. The ulcer did not heal and did not respond to treatment with mouthwashes, glycerine application, or any of the conservative modes of treatment.

The general practitioner kept treating her for more than two months but did not take it seriously and kept treating it, without referral to an oral medicine or oral pathology specialist. It was only when more symptoms developed, and the ulcer increased in size, that there was serious concern. Unfortunately, the general practitioner did not even think of cancer, as there were no related habits, and/or sharp traumatic margins of the teeth, so that by the time the referral was made the cancer had become well-developed and involved deeper areas.

When I examined the patient the cervical lymph nodes were also involved and I gave the diagnosis of squamous cell carcinoma immediately, taking a biopsy of the ulcer and sending it for histological examination. The report was 'squamous cell carcinoma, keratinising, moderately-differentiated' and 'surgical margins of resection involved by tumour'.

Surgery had to be extensive, with cervical node dissection, and it was very disfiguring.

Needless to say, the patient was mentally traumatised and went into depression. Unfortunately, the patient has stopped coming for follow-up. When I discussed the aetiology with the surgeon and other pathologists, human papilloma virus was the commonest answer. There has been a marked rise in such cases across the globe and sexual habits and practices seem to be the major cause. It is estimated that the frequency of oral cancer due to HPV is greater than for other causes such as tobacco usage.