Oral squamous cell carcinoma (OSCC) is a common malignancy of the head
and neck region. OSCC has a relatively low survival rate and the
incidence of the disease is increasing in some geographic areas. Staging
and grading of OSCC are established prerequisites for management, as
they influence risk stratification and are the first step toward
personalized treatment. The current AJCC/UICC TNM staging (8th edition,
2017) of OSCC has included significant modifications through the
incorporation of depth of invasion in the T stage and extracapsular
spread/extranodal extension in the N stage. Further modifications for
AJCC 8 have been suggested. On the other hand, the World Health
Organization (WHO) classification (4th edition, 2017) still endorses a
simple, differentiation-based histopathologic grading system of OSCC
(despite its low prognostic value) and ignores factors such as tumor
growth pattern and dissociation, stromal reactions (desmoplasia, local
immune response), and tumor-stroma ratio. The various controversies and
possible developments of the current staging and grading criteria of
OSCC are briefly discussed in this update together with possible
applications of artificial intelligence in the context of screening and
risk stratification.