Dark spots in your mouth can be caused by a variety of things. They run from minor lesions, such as a stain from a dental filling that leaked into your gums (called an amalgam tattoo), to benign tumors of your blood vessels, such as a hemangioma. Some types of cancer can also show up as dark spots. Melanomas (skin cancers), for example, are famous for looking like dark spots. Even though most people associate melanomas only with sun-exposed areas such as your skin, in fact, they can occur in the mouth and even inside your nose and sinuses (areas that are not exposed to the sun). Your husband should have this area examined by a doctor to determine if further tests are necessary. Q2. I have a hard, pea-sized lump in my cheek along my jaw (near my molars but not in my gums). I can move it around. It is very small usually. When I’m sick, it swells up but doesn’t really hurt. I’m worried about cancer. What kind of doctor should I see? What kinds of tests will I likely need? Either your primary doctor or an ear, nose and throat specialist can help you to evaluate this lump. The area you are describing can either be inside the parotid gland (a salivary gland) or within lymph nodes of the upper neck. The fact that it swells up when you are sick suggests that it is more likely a lymph node. Since lymph nodes are like filters in your body and help you fight infections, they will become bigger when you are sick. As long as it goes back to its normal size afterwards, there is probably nothing to worry about. A mass in the parotid gland can be many things, including a benign (non-cancerous) tumor. One way to diagnose what type of mass this is, is by fine needle aspiration. In this procedure, a doctor will insert a small needle into the mass and remove some cells. A pathologist can then examine these cells under a microscope to determine the diagnosis. Q3. The back of my neck has been bothering me for months now. It feels like there is something on the top of my spine when I move my neck. I have been under a lot of stress lately and have just been taking Advil (ibuprofen) twice a day about three times a week or when needed. It was just two days ago that I found a round red spot on the back of my mouth near my throat. This led me to some concern because occasionally I have been smoking. I have now stopped immediately when I found it. My throat has been sore, and I had it checked for strep, but it came back negative. My question is what does cancer look like in the mouth? Should I be concerned? I am really nervous. Thanks. Stress is a real problem in our busy world. It can result in lack of sleep, poor diet, and there is increasing evidence connecting stress to lowered immunity. Oral lesions can develop during times of stress due to changes in the balance between bacteria, viruses and even fungi that normally live in our mouths. Stress can also reduce the body’s ability to heal small injuries that occur on the lining of our mouths. The combination of these factors can result in lesions and ulcers that are often painful and discolored. Many cold sores and aphthous ulcers fall into this category. These lesions should heal in one or two weeks. Oral rinses with a dilute alcohol mouth wash or salt water should help keep them from becoming infected and may speed up healing. Any lesions that persist or bleed after two weeks should be evaluated by your doctor. Q4. Do spicy foods cause mouth cancer? This is a very interesting question and one that I get from many of my patients who enjoy a little “bam!” with their meals. I’ve researched this question on several occasions, and while there are a lot of studies into the role of certain spices and spicy foods with respect to reflux disease (GERD) and the esophagus, there is very little data to suggest that the average consumption of spicy foods can lead to mouth cancer. In some large population studies, the frequent consumption of spicy foods does come up as a potential risk factor. But rarely is this a single risk factor. Often, these are also the same groups of people who also smoke and drink — known high-risk behaviors for mouth cancer. The real answer is that we just don’t know if there is a clear connection. Part of the problem is that it is hard to standardize what we mean by “spicy food” because this can vary tremendously from person to person and culture to culture. Recent studies do show that eating a wide variety of foods — including whole grains and green leafy vegetables — and decreasing consumption of fatty foods can all lead to lower incidence of many common types of cancers. Weight loss is extremely beneficial in lowering cancer risk. So the best advice I can give is to listen to what your mother used to say: Eat right. Eat a lot of vegetables. Don’t eat too much. Get plenty of exercise. And don’t smoke. Everything in moderation — even the occasional spicy meal. Q5. Do X-rays increase your risk for cancer of the salivary glands? If they do, should I limit the number of X-rays I get as part of general dental care? Large amounts of ionizing radiation to the head and neck has been shown to increase risks of certain cancers, including those of the skin, soft tissue (sarcoma), bone and thyroid. These effects are seen many years and sometimes several decades after the initial treatment. Therefore, those at greatest risk are adults who have received large doses of radiation during childhood, usually as therapy for pediatric cancers such as lymphomaor leukemia. There is a clear association between radiation dose and risk. Dental X-rays deliver a relatively small dose of radiation, so the risk of developing cancers from routine dental X-rays is exceedingly low for most people. If you are concerned, however, you can always ask to have other parts of your body covered with lead shields during these procedures. Q6. I’m trying to quit coffee, and a friend of mine suggested mate tea as an alternative. I was reading about it and found that it might increase your risk for oral cancer. Is that true? Mate tea is made by steeping dried leaves of the Yerba mate plant and is drunk in many South-American countries. There is evidence in the literature that mate consumption is in itself carcinogenic and plays a role in the development of cancers of the oral cavity and oropharynx (the back of the mouth and upper throat). In one study, those drinking more than one liter per day of mate at a very hot temperature had a three-fold increase in risk of esophageal cancer. Other studies have shown that consumption of very hot beverages like mate can lead to oral cancers. Although the exact mechanism of how mate contributes to cancer is still unknown; available information suggests that mate drinking should be considered one of the risk factors for oral and oropharyngeal cancer. For people who also smoke and drink alcohol along with drinking mate, the risks are increased further. So if you want to drink mate or already do, the keys to decreasing your risk are to drink in moderation (less than half a liter a day), to drink it at warm or cool temperatures, rather than piping hot, and not to smoke or drink a lot of alcoholic beverages. Q7. I read on the Internet that if you want to save your teeth after radiation for mouth cancer, you need to maintain a very strict dental hygiene routine. This includes using a sonic toothbrush, a rubber-tip tool for the gums, a tiny brush in between the teeth and a water pik for rinsing. Also, you’re supposed to use an over-the-counter fluoride gel. Does this sound true? A thorough dental examination is an absolute must prior to any radiation therapy to the oral cavity. Radiation therapy can often worsen existing dental problems, so cavities should be treated and, in some cases, diseased teeth should be extracted before treatment begins. Maintaining good dental hygiene during radiation will go a long way in preventing serious complications. All of the techniques you list are helpful. In addition, your dentist may recommend a dental tray designed for fluoride treatments during your radiation therapy. Also, talk to your dental health professional about the type of toothpaste and toothbrush best suited for your particular set of teeth. Q8. Can sun exposure cause lip cancer? I use sunblock religiously on my skin, but I often forget about my lips. Like other parts of your skin, your lips are susceptible to the damaging effects of UV radiation associated with prolonged sun exposure. This can lead to both premature aging and certain skin cancers including basal cell carcinoma and squamous cell carcinoma. Cancers of the lower lip are more common mainly due to the fact that the upper lip tends to receive less direct sunlight due to hats designed to shade the eyes. Often, a precancerous or cancerous lesion may appear as a scaly or crusted wound that won’t heal or go away. These should be evaluated by a dermatologist or an ear, nose and throat (ENT) specialist and may require a biopsy. If you are in the sun a great deal, there are many products that provide UV protection for your lips. These include certain lipsticks, lip balms and products with zinc oxide. Water and snow will greatly increase sun exposure to the face and lips because of their reflective properties, so I recommend protecting your lips if you are planning a day at the beach or on the slopes. And while you are at it, don’t forget to protect your nose and your ears as well. Q9. At the base of my tongue in the back of my mouth, I have a lump that is the size of a penny. It is a yellowish-brownish color. It was discovered by my ear, nose and throat doctor. I was then sent to a specialist who said he couldn’t even find what the ENT was talking about. In the meantime it is getting larger. Could this be cancer? Suspicious lesions or sores in the oral cavity often need to be biopsied in order to be diagnosed. Ulceration, bleeding, pain and growth can all be signs of a more serious condition. If your mass comes and goes, it may be a vascular lesion (a benign growth of small blood vessels). Depending on when you saw the specialist, the lesion may or may not have been readily apparent. Other benign lesions in the back of mouth include clusters of lymphatic tissue not unlike your tonsils. If you continue to have concerns about this area, I would discuss it with either your ENT physician or head and neck specialist and make sure you can be evaluated quickly when the lesion is visible to you. That way, there is a good chance that your doctor can see what you are seeing. Your local ENT physician can also take pictures of the lesion so that the specialist can see what he or she is seeing. Q10. I have a red spot in the top of my mouth – I believe it is called the hard palate. It bleeds sometimes, and there is some pain and burning from time to time. I am concerned it might be cancer. Any lesions in the mouth that persist and don’t get better with time should be evaluated by your doctor. Of particular concern are areas that are ulcerated (open sores), painful or are prone to bleeding. Not all areas that meet these criteria are cancerous, however, but a biopsy may be needed to differentiate between cancer and other causes, such as an infection. Some benign tumors of the mouth can have similar features, so an early diagnosis is key. Learn more in the Everyday Health Oral, Head, and Neck Cancer Center.
