Benign bulges: Demystifying malignancy in buccal fibromas and giant cell fibromas
Fibromas and giant cell fibromas (GCF) are two common benign growths in the buccal mucosa, but what about their potential for malignancy? Here’s a look at the facts.
Fibromas
These are the most common fibrous tumors of the oral cavity, accounting for roughly 50% of all such lesions. They typically appear as slow-growing, painless, firm, and pink or red nodules, rarely exceeding 1 cm in diameter. While fibromas in the buccal mucosa are inherently benign, with a malignancy risk close to zero, it's crucial to differentiate them from other potentially precancerous lesions.
You might also want to read: The fibroma: Breaking a chronic habit
Giant cell fibromas
These distinctive growths, comprising about 2% to 5% of oral fibrous lesions, share some similarities with fibromas but stand out due to their unique microscopic features. Large, star-shaped, and multinucleated cells called osteoclast-like cells are their hallmark. Like fibromas, giant cell fibromas in the buccal mucosa are rarely malignant, making their presence more of a cosmetic concern than a health risk.
Malignant mimics
While the malignancy risk for both fibromas and giant cell fibromas is negligible, it's essential to be aware of rare conditions that can mimic their appearance. Sarcomas can sometimes present as firm, painless nodules. Careful clinical examination and, if necessary, a biopsy under a dentist’s or oral surgeon’s guidance can help rule out any malignancy concerns.
Diagnosis and management
Both fibromas and giant cell fibromas are usually diagnosed clinically based on their appearance and location. In most cases, if the lesion starts to show atypical features, an excisional biopsy is the recommended treatment of choice in both cases; the histopathological report will leave you and your patient at ease once you can confirm the clinical diagnosis1 of fibroma or GCF. However, the resolution of the lesion-associated chronic inflammation factor is also necessary to prevent a recurrence.2
Remembering the key takeaway
Early detection is vital for any health concern, and both fibromas and giant cell fibromas in the buccal mucosa are incredibly unlikely to turn malignant. While vigilance is always recommended, these bumps are typically harmless and often require an excisional biopsy and observation. But remember that it is important always to record any unusual changes in the size, color, or texture of any oral lesions.
References
- Błochowiak K, Farynowska J, Sokalski J, Wyganowska-Świątkowska M, Witmanowski H. Benign tumours and tumour-like lesions in the oral cavity: a retrospective analysis. Postepy Dermatol Alergol. 2019;36(6):744-751. doi:10.5114/ada.2018.78805
- Cohen PR. Biting fibroma of the lower lip: a case report and literature review on an irritation fibroma occurring at the traumatic site of a tooth bite. Cureus. 2022;14(12):e32237. doi:10.7759/cureus.32237
Andreina Sucre, MSc, RDH, is an oral pathology and oral surgery specialist, and a practicing dental hygienist in South Florida. She’s a speaker, writer, and advocate for early pathological diagnosis. Andreina was born in Venezuela where she earned her dental degree in 2002 from Universidad Santa Maria. In December 2005, she earned her certificate and specialization degree in oral pathology and oral surgery from Pontificia Universidad Javeriana, in Colombia. Follow her on Instagram @ThePathoRDH.
