Irritation Fibroma Masquerading as Oral Squamous Cell Carcinoma in a Young Tobacco User: A Case Report

Abstract

Background: Irritation fibroma, also known as traumatic fibroma, is a benign reactive lesion of the oral mucosa associated with chronic mechanical irritation. Because its clinical appearance may overlap with other persistent oral mucosal lesions, including oral squamous cell carcinoma (OSCC), accurate diagnosis requires careful clinicopathological correlation.

Case Presentation: A 29-year-old man with an 11-year history of tobacco use presented with a 1.8-cm lesion of the buccal mucosa that had remained unchanged for approximately two years. The lesion was located adjacent to a sharp, fractured cusp producing chronic mechanical irritation. Because of the patient’s tobacco history and the persistence of the lesion, the referring dentist raised a provisional clinical suspicion of OSCC. On examination, however, the lesion was non-indurated, non-fixed, and non-ulcerated, with no documented increase in size or regional lymphadenopathy. The offending cusp was smoothened, followed by complete excision of the lesion. Histopathological examination demonstrated dense collagenized fibrous connective tissue with fibroblastic proliferation and an overlying hyperkeratotic, acanthotic epithelium without dysplasia, consistent with irritation fibroma.

Conclusion: Persistent oral mucosal lesions in patients with tobacco exposure warrant careful evaluation, but tobacco history alone should not determine the clinical diagnosis. In this case, the absence of induration, fixation, ulceration, and progressive growth, together with an identifiable source of chronic mechanical irritation, supported a benign reactive process that was confirmed histopathologically. Excisional biopsy remains important when clinical findings are insufficient to exclude malignancy.