Multiple primaries in mouth cancer--the price of success.

Successful locoregional control in the treatment of oral cancer has been achieved at the expense of an increase in the occurrence of distant metastases and the emergence of second primary tumours. The head and neck are the commonest sites for second primaries which occur in 10 to 20% of patients. This study represents a detailed prospective analysis of 105 oral squamous cell carcinomas which could be followed-up until death or March 1987. Recently, interest has been focused on the role of screening such patients using triple endoscopy not only at initial diagnosis and assessment of the index tumour but also at follow-up after definitive treatment. However, the outlook for these patients is so poor, as confirmed by this study, that screening of frail elderly patients is hard to justify.