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365 doi: (Published 05 June 2019) Cite this as: BMJ 2019;365:l2142 Pankaj Chaturvedi, professor1, Arjun Singh, fellow, head and neck oncology1, Chih-Yen Chien, professor2, Saman Warnakulasuriya, professor3 1 Tata Memorial Hospital, Mumbai, India 2 Kaohsiung Chang Gung Memorial Hospital, Taiwan 3 Kings College, London Correspondence to: P Chaturvedi chaturvedi gmail.com What you need to know Smoking and use of chewed forms of tobacco are the most common causes of oral cancer Patients present with a persistent non-healing ulcer in the mouth or a growth, and may have impaired speech and chewing as a result Encourage those who use tobacco to attend an annual oral visual examination to detect early lesions such as white or red patches in the mouth or fibrosis limiting opening of the mouth Immediately refer patients with a suspicious lesion and history of tobacco use to a specialist for imaging and biopsy to confirm diagnosis Surgical excision of the tumour is warranted in most patients, and reconstructive surgery can minimise disruption of facial features and function to an extent Oral cancer accounts for over 140 000 deaths annually across the world

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~*~ Essay #66 Principle of unity as Americans, preventing faction or division through election only of representatives who understand the United States Constitution and are willing to uphold it

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Cairns Coralyn Cairns is a Freshman at Lakeside Highschool in Georgia and is enrolled in the International Baccalaureate program there