Source: Oral and Maxillofacial Pathology doi:10.1016 Author: Mark W. Lingen, DDS, PhD Section Editor, Oral and Maxillofacial Pathology Head and neck squamous cell carcinoma (HNSCC) is the 6th most common malignancy in the world today.1 Despite numerous advances in treatment, the 5-year survival rate has remained modest. This poor outcome is due to several factors, including delayed diagnosis. Therefore, improved early detection and effective prevention strategies are critical components for management of this malignancy. The etiology of classical HNSCC has been attributed to chronic exposure to tobacco and alcohol.2 In addition, there is now sufficient evidence to support the contention that high-risk forms of the human papillomavirus (HPV) are a major causative factor for HNSCC of the tonsil, base of tongue, and oropharynx.3-8 The increasing importance of HPV in oropharyngeal HNSCC has raised considerable concern and uncertainty among healthcare professionals and patients. For example, I am often asked to describe the clinical features of HPV-associated premalignant lesions. Unfortunately, to my knowledge, the clinical spectrum of HPV-associated premalignant disease has not been adequately described. Furthermore, because this subset of HNSCC often develops in hard to- examine locations, such as tonsillar crypts, it can be exceedingly difficult to even identify the carcinomas. In the absence of such information, how can clinicians identify patients that are at increased risk for harboring an HPV-associated premalignant lesions or HNSCC? Recently, a large commercial diagnostic lab began offering a saliva-based test for the identification of oral HPV infections. As a result of this new offering, I [...]