Relapse and Second Malignancy
Gingival infiltrates, oral infection, and/or bleeding disproportionate to local etiology can indicate possible relapsed disease, especially in patients treated for leukemias or lymphomas. Additionally, localized oral plasmacytomas have been observed in patients relapsing early post–autologous transplantation for multiple myeloma. Painless unilateral lymphadenopathy can also represent relapse in patients with previously treated lymphoma. Lymphoproliferative diseases occurring as second primary malignancies posttransplant must be considered for soft tissue masses and lymphadenopathy noted in transplant recipients.
Incidence of second malignancy steadily increases as cancer patients survive longer posttransplant. Previous exposure to chemotherapy and radiation therapy and alterations in immune function, graft-versus-host disease (GVHD), and GVHD therapy collectively contribute to risk of second malignancy. Oral squamous cell carcinoma is the most frequently occurring secondary oral malignancy in transplant patients, with the lips and tongue being the most frequently reported sites.