Background: Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity and a persistent public health concern. Although data exist from several regions of Iran, epidemiological evidence from the Southeast, particularly Zahedan, is scarce.Methods: This cross-sectional study included all histopathologically confirmed OSCC cases diagnosed at the Zahedan School of Dentistry between January 2021 and December 2023 (n = 63). Demographic, clinical, and behavioral information (cigarette, hookah, smokeless tobacco/snuff, and opium use) was collected from clinical records and structured interviews. Categorical variables were compared using Chi-square or Fisher’s exact tests, as appropriate. All tests were two-tailed with α = 0.05Results: The mean age was 54.2 ± 12.9 years (range 36–85), and 54.0% were women. Most participants (81.0%) self-identified as Baloch, reflecting the catchment population. The floor of the mouth was the most frequent site (38.1%), followed by mandibular gingiva (28.6%) and tongue (12.7%). Reported exposures included snuff (67.3%), cigarettes (54.0%), hookah (54.0%), and opium (47.6%); categories were not mutually exclusive. At presentation, 79.4% of lesions measured more than 3 cm. Delays in seeking care beyond three months were more common among patients aged ≥ 50 years (P = 0.012) and smokers (P = 0.019). Pain as a presenting symptom was reported more often by women (P = 0.020) and patients under 50 years (P = 0.023)Conclusions: In Southeast Iran, OSCC frequently presented with large lesions, floor-of-mouth predominance, and high rates of self-reported smokeless tobacco use.These descriptive findings underscore the need for early detection,..