The oral cavity is the site of many different types of localized swelling, including reactive, benign neoplastic and malignant neo-plastic proliferations. The biologic behavior of each is distinctly different, but they can occasionally display similar clinical features. Any persistent intraoral swelling should be viewed with suspicion, since squamous cell carcinoma, the most common intraoral malignancy, often presents clinically in this fashion. Lesions to be differentiated from squamous cell carcinoma are either reactive tumors (such as the pyogenic granuloma, fibroma, mucocele, ranula, and traumatic neuroma) or benign neoplastic tumors (such as the squamous papilloma, torus palatinus, torus mandibularis, and hemangioma). The first step is an adequate medical history focusing on the onset, rate of growth, and symptoms of the lesion, and specific cancer risks identified in the patient. The next step is a complete, systematic examination of the oral cavity. A number of specific clinical features can be used to distinguish between reactive and benign neoplastic tumors: most importantly, color, surface configuration, mode of attachment, consistency and location.
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