Oral squamous cell carcinoma (OSCC) is the predominant oral malignancy, constituting 80-90% of all malignant neoplasms in the oral cavity. The global prevalence of oral cancer fluctuates considerably, with the oral cavity positioned as the 6th to 9th most prevalent cancer site, contingent upon the country, area, and patient demographics [1]. Oral squamous cell carcinoma primarily impacts those over 40 years of age, while it is very uncommon in young adults. [2] Recent trends reveal a shift, with research from many regions of India, including Kerala, demonstrating a rising incidence of OSCC among young adults [3]. The incidence rate of oral cancer is increasing in Asia, with changes noted in parameters such as location, male-to-female ratio, age, and prevalence among individuals without identifiable risk behaviors. [4] Oral cancer cases within a short period, characterized by diverse age groups, genders, and clinical sites, has raised concerns[5]. Despite its significance, research on the distribution of age, gender, and clinical sites of oral cancer in the Malabar region of Kerala remains scarce in existing literature. This study aims to investigate the distribution of age, gender, and clinical sites of oral cancer in a single tertiary care centre in the Malabar region over a five-year period. Furthermore, it seeks to identify any shifts in the typical demographic and clinico-pathological trends associated with oral cancer. By exploring the demographic and clinical characteristics of oral cancer in this region, this study will contribute valuable insights to the existing body of knowledge. The findings will facilitate a better understanding of the disease's epidemiology, ultimately informing strategies for prevention, early detection, and management of oral cancer in the region.

The records of patients who were histologically diagnosed with squamous cell carcinoma of the oral cavity at the Department of Oral and Maxillofacial Surgery, Government Dental College Kozhikode between 2020-2024 were retrospectively reviewed. The study was approved by the Institutional Ethics Committee, Government Dental College, Kozhikode, with IEC No: 333/ 2025/ DCC dated 15/04/2025. The data extracted were analysed for demographic details like age, gender and clinico-pathological details including clinical site, tumour differentiation. Data were entered in excel sheet and analysis done by Software Statistical Package for Social Science (SPSS) software, Version22. All the qualitative variables are expressed in frequency and percentage. Descriptive analysis were done based on collected data.

A retrospective study was conducted to analyse the demographic and clinic-pathological features of OSCC cases over a five-year period, spanning from 2020 to 2024. Out of a total of 1116 cases of OSCC diagnosed over a 5-year period, a significant proportion were found to affect male patients. Specifically, 734 cases (65.8%) were reported in males, while 382 cases (34.2%) were reported in females. Distribution Of Cases By Age: N Minimum Maximum Mean Std. Deviation AGE 1116 23 95 62.42 12.014 Among the total of 1,116 reported cases, the age of patients ranged from 23 to 95 years. The minimum reported age was 23 years, while the maximum was 95 years. The mean age was 62.42 years, with a standard deviation of 12.014, indicating a wide age distribution among the affected individuals. For ease of analysis, the patients were categorized into 3 age groups: 1. Group 1: 23–45 years 2. Group 2: 46–65 years 3. Group 3: Above 65 years Each age group was studied separately to assess the most commonly affected clinical sites and the corresponding grades of histopathological differentiation. This categorization allowed for a more detailed understanding of age-related patterns in the site of involvement and tumour differentiation in OSCC. Among patients aged 23 to 45, 68.9% of OSCC cases were moderately differentiated, making it the most common histopathological grade. Poorly differentiated cases accounted for 22.3%, while 8.7% were well differentiated. The tongue was the most frequently affected site (54.4%), followed by the buccal mucosa (35.9%) and the alveolus (9.7%). For age group of 46-65 years, 44.9% of OSCC cases were moderately differentiated, 33.6% poorly differentiated, and 21.1% well differentiated, with 0.4% classified as undifferentiated. The buccal mucosa was the most commonly affected site, followed by the tongue, alveolus, floor of the mouth, soft palate, and hard palate. For the age group of 65 years above, 44.7% of OSCC cases were moderately differentiated, 30.3% well differentiated, and 23.8% poorly differentiated, with 1.1% undifferentiated. The buccal mucosa was the most commonly affected site, followed by the tongue, alveolus, floor of the mouth, gingiva, hard palate, and lip. Distribution Of Cases Based On The Location Of OSCC: According to the percentage distribution of affected sites, the majority of cases were reported in the buccal mucosa, accounting for 41.6% of the total cases. This makes it the most commonly involved site among all reported cases. The tongue was the second most common affected site, with 35.2% of the cases diagnosed there. The alveolus accounted for 15.5% of the cases, while the floor of the mouth was affected in 4.7% of cases. In contrast, significantly fewer cases were reported in other areas of the oral cavity. The hard palate was involved in 1.9% of cases, the soft palate in 0.6%, and the gingiva in 0.3% of cases. Notably, the lip was the least affected site, with only 0.2% of the total cases reported.

Traditionally, OSCC has been associated with older adults[6-8]. However, a notable shift has been observed. Starting in the late 1970s, oral and maxillofacial healthcare professionals began highlighting an increased incidence of oral cancer among young adults[9]. This trend was further confirmed by retrospective studies in the late 1980s, which showed a rising prevalence of head and neck cancer, particularly tongue cancer, in young adults in North America and globally[10-12]. This demographic shift underscores the need for increased awareness and vigilance among healthcare professionals and the general public, as OSCC can no longer be considered exclusive to older adults. [13] In India, oral cancer is the leading malignancy among all cancers in men and third among cancers in women. Similar to the pattern in the rest of the country, the oral cancer scenario in Kerala is quite alarming, and most cases are reported in the late stages, further decreasing the 5-year survival rates.[14] Kerala has always been lauded when it comes to health infrastructure and high literacy, but the statistics of chronic debilitating diseases such as cancer show that despite the high health indices among contemporaries, our masses are still ignorant or unaware of the deleterious effects of tobacco usage. This shows the lack of effective comprehensive oral health awareness programs in Kerala.[3] This study investigated the demographic, clinical, and histological features of oral cancer cases at our institution. About 1,116 patients were identified with OSCC during the study period. This comprehensive review offers significant insights into the prevalence and distribution of OSCC within the regional population. Additionally, it enhances our understanding of site-specific occurrences and emerging trends associated with the disease. A notable majority of these cases occurred in male patients comparing with female patients, these results are matches with study conducted by Gajurel R, Gautam DK et al.[1] Our results suggests a strong site-specific predilection, likely influenced by localized exposure to risk determinants such as tobacco placement and chewing habits. The grade of differentiation in OSCC varied by site, with well-differentiated tumours most common in the buccal mucosa and absent in the gingiva, hard palate, and soft palate. Moderately differentiated tumours predominated across most sites, while poorly differentiated cases were mainly seen in the tongue; undifferentiated tumours were reported exclusively in the buccal mucosa. These findings suggest a site-specific pattern in tumour aggressiveness, with the tongue and buccal mucosa showing a higher prevalence of poorly and undifferentiated cases, potentially indicating more aggressive disease at these locations and the need for heightened clinical attention. Findings are in line with study done by Sherin N et al. [5] Timely identification of oral cancer is essential for enhancing patient outcomes and survival rates.[15] When diagnosed at an initial stage, oral cancer is often more treatable and less likely to require aggressive interventions, reducing both physical and emotional burdens on patients. Timely identification allows for more effective management, minimizing the risk of metastasis and extensive tissue damage. Moreover, early diagnosis can significantly lower healthcare costs by avoiding complex treatments and prolonged hospital stays. As oral cancer can progress rapidly, regular screenings and prompt attention to suspicious symptoms such as persistent sores, lumps, or changes in oral tissues are essential in catching the disease before it advances. [16-18] Raising awareness about oral cancer among the young adults is equally important, as increasing risk habits such as tobacco use, alcohol consumption, and betel quid chewing are often established early in life.[19] Educating young people on the signs, symptoms, and risk elements of oral cancer empowers them to seek medical advice sooner and adopt healthier lifestyle choices. [20] Awareness campaigns targeting youth can foster preventive habits, encourage regular oral check-ups, and dispel myths surrounding the disease. By focusing on this demographic, public health initiatives can help reduce the incidence of oral malignancies and promote a culture of early detection, ultimately saving lives and improving quality of life.[21]

Our study reveals a notably high incidence of OSCC among young adults in the region, with the tongue identified as the most frequently affected site. While the exact causes of OSCC in these cases remain uncertain, this area warrants further focused research to uncover underlying etiological factors. OSCC poses a significant public health challenge in our country; however, the true scale of the problem remains unclear due to the predominance of small-scale, institution-based studies. Conducting larger, comprehensive investigations that include both institutional and community settings is essential to fully understand the disease’s scope and characteristics. Such efforts will be instrumental in developing effective prevention and control strategies tailored to the population’s needs.

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