This report describes a case of carcinoma cuniculatum that presented initially as keratosis and ulceration of the gingiva when the patient attended for extraction of a persistently painful tooth in the right mandible. A series of mucosal biopsies and subsequent reviews showed hyperkeratosis associated with chronic candidosis and mild dysplasia but no evidence of neoplasia. However, vague symptoms of pain persisted in the mandible over a six-year period when the clinical signs were then consistent with osteomyelitis. A later biopsy included bone and indicated a diagnosis of carcinoma cuniculatum, a tumour that only rarely presents in the mouth. This necessitated radical excision of bone and grafting. Gingival lesions that initially appear innocuous may have the potential for malignant change. Biopsies of what might appear to be pre-malignant lesions usually ensure that invasive pathology is detected early. In this instance, however, the nature of the lesion meant that the carcinoma cuniculatum was only diagnosed following the more radical biopsy of bone.
Keywords: carcinoma, papillary, verrucous, mandibular neoplasia