Abstract Background: Basrah city is one of the most affected areas by oral cancer, with increasing concern due to the rising number of reported cases. Cases are spread across different locations, communities, and regions within Basrah, suggesting multiple potential contributing factors. Methods: A total of 411 oral cancer cases were recorded in Basrah city (Iraq/Basrah), including data on age, sex, address, year of diagnosis, histopathological diagnosis, and the affected site. Data were collected from 2005 to 2025. Cases of malignancies in the oral and facial regions with usual residence outside Basrah were excluded. Data were gathered from records at the Histopathological Research Facility of Al-Sadder Teaching Hospital, Al-Basrah General Hospital, the College of Dentistry in Basrah, and several private clinics. This study emphasizes the importance of understanding the geographical and demographic patterns of oral cancer in Basrah and highlights the need for targeted public health strategies and prevention measures. Results: Analysis of 411 oral malignant cases from 2005 to 2025 showed that 51. 51.6% were males and 48. 4% were females. The highest incidence was in 2011 (10. 2%), followed by 2009 (8. 5%) and 2010 (8. 0%). Squamous Cell Carcinoma (SCC) was the most common, making up 84. 4% of cases. Other diagnoses included Non-Hodgkin's Lymphoma (3.2%), Basal Cell Carcinoma (2. 4%), Verrucous Carcinoma (2. 4%), and Adenoid Cystic Carcinoma (1. 7%). The tongue was the most frequently affected site (47. 0%), followed by the lower jaw (16. 8%), lower lip (6. 8%), and cheek (6. 8%). Patient ages ranged from 4 to 92 years, with a mean age of 53. 39 years and a median age of 55 years. The highest number of cases was in Al-Zubair (25%), followed by Al-Madina and Al-Basrah Alqadima (12. 5% each), and then Al-Karma and Abu Al-Khasib (10% each). Conclusions: Basrah is one of the most affected regions by cancer, with oral cancer representing a major concern due to the increasing number of cases. Contributing factors include environmental, behavioral, genetic, and socio-economic aspects such as lifestyle, age, sex, genetic predispositions, pollution, and the city's historical context, all of which significantly influence the incidence of oral cancer.