Essential next steps

1. Confirm the primary site: oral cavity, tongue, buccal mucosa, lip, oropharynx, larynx, nasal cavity, esophagus, vulva, cervix, anus, etc. These have different treatment pathways.
2. Review the biopsy: depth of invasion, margins if excised, perineural invasion, lymphovascular invasion, and for oropharyngeal tumors, p16/HPV status.
3. Stage the disease:
   • Thorough examination of lesion and neck lymph nodes
   • Contrast CT or MRI of the primary site and neck
   • Chest imaging, often CT chest
   • PET-CT in selected advanced cases
   • Dental assessment before head-and-neck radiotherapy
     Cancer stage describes tumor extent, lymph-node involvement, and distant spread, and is what guides treatment selection, as outlined by the NCI staging overview.

If this is oral cavity mucosal SCC such as tongue, floor of mouth, gum, or buccal mucosa

• Early, operable disease: usually wide surgical excision with clear margins. Management of neck lymph nodes is often required, commonly selective neck dissection or sentinel-node evaluation depending on depth of invasion and site.
• High-risk pathology after surgery:
  • Postoperative radiotherapy for factors such as close margins, larger/deeper tumor, multiple positive nodes, perineural invasion, lymphovascular invasion, or extranodal extension.
  • Postoperative chemoradiotherapy, often cisplatin-based if medically suitable, particularly for a positive margin that cannot be re-excised or extranodal extension.
• Unresectable disease or patient not suitable for surgery: definitive radiation with concurrent systemic therapy, often cisplatin if eligible.
• Recurrent/metastatic disease: systemic therapy, which may include pembrolizumab-based treatment depending on PD-L1 testing, symptoms, prior treatment, and fitness. Recent reviews describe a rapidly changing role for immunotherapy in resectable head-and-neck SCC, but it should be chosen within a specialist team and not substituted for standard curative surgery/radiotherapy when those are appropriate (recent systematic review).

Important now

• Do not delay specialist referral while waiting for symptoms to worsen.
• Stop tobacco, betel/areca nut, and alcohol exposure if applicable.
• Maintain nutrition and oral hygiene. Seek urgent care for bleeding, breathing difficulty, inability to swallow fluids, severe pain, or rapidly enlarging neck swelling.