Endoscopic submucosal dissection of early squamous cell carcinoma of the soft palate

A 52-year-old man was incidentally found to have a 2.0-cm ×1.5-cm superficial flat lesion (0-IIb) in the right soft palate during gastroscopy on July 5, 2018. The surface of the lesion was bloodshot and rough, with an irregular but clear boundary (A). The lesion turned brown in narrow-band imaging mode (B). Histopathologic examination identified squamous cell carcinoma (SCC). This patient was an active heavy smoker and drinker. He also received a diagnosis of multiple synchronous early-stage esophageal and hypopharyngeal SCC. No enlarged lymph nodes were found on enhanced CT. We performed endoscopic submucosal dissection (ESD) for all lesions; no adverse events, such as bleeding or perforation, occurred (C). The maximum postoperative pain level was 8 on the visual analogue scale and was relieved after morphine was given. The oral pain gradually alleviated, lasting for 2 weeks after ESD. Pathologic examination of the soft palate specimen showed moderately differentiated SCC (Supplementary Fig. 1, available at www.giejournal.org), and no tumor was found in the lateral and vertical margins of the mucosa. The follow-up examination showed no recurrence or lymph node metastasis during the routine gastroscopy and CT scan (D). Although ESD is limited to the narrow space on the soft palate, its adoption for SCC of the soft palate has the advantage of a clear margin of the whole surgical field. It embraces the features of minimal invasion and maintains the integrity of the organs.