Premalignant lesions of oral cavity for medical students. Oral cavity proper lies behind and within the arch of teeth. Review article an update on precancerous lesions of oral. Because the oral cavity is easy to examine and risk factors for oral cancer are known, there is great opportunity to improve patient outcomes through diagnosis and treatment of premalignant lesions before the development of invasive oral carcinoma. The aim of this study was to evaluate our experience utilizing various treatment modalities for oral cavity premalignant lesions. The first 4 categories must be ruled out before figure 1. This lesion may be a result of a hypersensitivity reaction to dietary constituents such as betel nut, capsaicin, etc. A precancerous lesion is a morphologically altered tissue in which oral cancer is more likely to occur than in its apparently normal counterpart, for.
The varied appearance of oral premalignant lesions and early oral cancer on the lateral aspect of the tongue. Oral cancers are attributed to a number of causal agents including tobacco, alcohol, human papillomavirus hpv, and areca betel nut. To date, the literature regarding this topic is not complete. Interest in the site of biopsy has come about in light of data demonstrating an increased prevalence of hpv16 specifically in oropharyngeal carcinomas. Immunological and classical subtypes of oral premalignant. The serially increasing c fos expression from normal mucosa to premalignant lesions to scc and in dysplasias suggests that it could be an early gene to get activated and form transcription factor activator protein 1ap1. For these lesions, the recommended depth is 4 or 5 mm. Oral lesions appear as areas of opacification with loss of elasticity. Young, use of carcinogeninduced premalignant oral lesions in a dendritic cellbased vaccine to stimulate immune reactivity against both premalignant oral lesions and oral cancer, journal of immunotherapy, 10. Premalignant oral lesions ontario dental association. Inspect and palpate lateral borders from anterior to posterior with manual retraction.
The discovery of insulin treatment justified a close correlation between the disorder of the carbohydrate metabolism. Oral precancerous lesions and anatomy of oral cavity 1. The site of the majority of our lesions were the oral cavity, given that oral premalignant lesions are more common, more likely to be detected on routine clinical exam, and more easily biopsied. The oral squamous cell carcinoma oscc is the most frequent type and comprises 90% of all malignancies of the oral cavity.
Progressive rise of c fos expression from premalignant to. Practitioners will see many oral white lesions but few carcinomas. Lesion of mucosa similar to lichen planus due to drugs lichenoid dermatitis. Surgical treatment of premalignant lesions of the oral. Terms commonly used to describe oral lesions fixed a lesion that is nonmobile and firmly attached to the underlying structures mobile a movable lesion that does not appear to be connected to underlying structures indurated hard and firm tissue palpation that would normally be soft exophytic a lesion that appears to be growing outward from the mucosa. Ppt premalignant oral lesions powerpoint presentation. Oral cancer and precancerous lesions neville 2002 ca. In this video, we are going to see about premalignant lesions of oral cavity. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant. Although betel nut chewing has been established as an independent cause of oral cancer, the mechanisms of carcinogenesis are poorly understood. Pindborg department of oral and maxillofaeial surgery and oral medicine, university hospital. The pictures used in this presentation and its content has been obtained from a. Premalignant or precancerous also referred to as potentially malignant oral lesions involve the skin lining of the mouth known as the epithelium and may be at risk for becoming transforming into an oral cancer, although it is difficult to predict which lesions will transform and how long it will take.
Modified from ajcc manual for staging of cancer, 1997, ed. Selected chemoprevention trials are discussed with a focus on. Oral carcinogenesis proceeds through a stepwise accumulation of genetic damage over time. Pdf precancerous lesions of oral mucosa researchgate. An improved molecular classification of opl may help refining prevention strategies. Abstract in the united states, cancers of the oral cavity and oropharynx represent. Aetiology of premalignant lesions including up to date knowledge on. Clinically, these diseases may sometimes resemble each other. Premalignant changes arising in other oral lesions are uncommon. The results suggest that tobacco chewing was the most important risk factor for multiple oral premalignant lesions and may be a major source of. Protein expression profile of oral premalignant lesions opls. Overexpression of egfr in oral premalignant lesions and. The incidence of oral cancer worldwide varies 218% and in india 0.
Many oral sccs develop from premalignant conditions of the oral cavity. Various premalignant lesions, particularly red lesions and some white lesions have a potential for malignant change. Oral cavity anatomical and physiological specificities. Oral vestibule lies between the gums, teeth and inner lips, inner cheek. Leukoplakia and erythroplakia premalignant squamous. Biopsy and histopathologic diagnosis of oral premalignant and. In early stages, histopathological findings are distinctive, but if malignant transformation occurs, identical. White lesions such as linea alba, leukoedema, and frictional keratosis are common in the oral cavity but have no propensity for malignant transformation. These precancerous lesions include leukoplakia, erythroplakia, and the palatal lesions of reverse smokers.
The levels were compared with that in normal controls and chronic. We identified two main opl geneexpression subtypes, named immunological and classical, in 86 opl discovery. Premalignant conditions of the oral cavity ajlobby. However our understanding of the disease process and transformation from precancerous lesions of the oral mucosa to an invasive scc cancer and their progression has expanded exponentially. Premalignant lesions of the oral cavity represent an important target for cancer prevention. Precancerous lesions of oral mucosa, known as potentially malignant disorders in recent years, are consists of a group of diseases, which should be diagnosed in the early stage. Biopsies of the mucosa should be at least 3 mm in diameter. Management for premalignant lesions of the oral cavity. Download precancerous lesions of the gynecologic tract pdf. Quantitation of circulating immune complexes cic levels was established in patients with oral cancer and oral precancerous lesions.
Precancerous lesions of the gynecologic tract pdf and provides a comprehensive outline of morphologic, immunophenotypic and molecular attributes, and patient results. The effect of retinoids on premalignant oral lesions. These lesions represent clinical rather than histological diagnoses. Examination of these cases provides an opportunity to study the relationship between genetic, morphological, and clonal progression in these fields and. Photodynamic therapy of malignant and premalignant lesions. Realtime quantitative pcr demonstrates low prevalence of. Premalignant conditions of oral cavity free download as powerpoint presentation. It is the sixth most common cancer, approximately 3% of the total cancer burden and results in 128,000 annual deaths globally 1,2. Oral cancer makes up 34% of all cancers worldwide and is currently the sixth most common cancer. Oral cavity cancer accounts for approximately 3% of all malignancies and is a significant. Premalignant lesions of the oral cavity present as visibly abnormal areas of mucosa and may be a source of significant anxiety for the patient and the clinician. The two most important lesions are leukoplakia and erythroplakia both can occur in the same lesion, sometimes called erythroleukoplakia. Suspicious lesions should be biopsied to evaluate for dysplasia.
Pdf diagnostic techniques of oral premalignant lesions. Precancerous lesions of oral mucosa pubmed central pmc. Premalignant conditions of the oral cavity head and neck cancer clinics series by peter a. Oral precancerous lesions and anatomy of oral cavity. However, oral premalignant lesions and sccs frequently need deeper biopsies because of the characteristic thickened epithelial lining and hyperkeratosis. Pdf precancerous lesions of oral mucosa, known as potentially malignant disorders in recent years.
A cohort of head and neck cancer patients, without exposure to tobacco and alcohol, presented with multiple preneoplastic and neoplastic lesions, the natural history of which may span several decades. The most common of these lesions is squamous dysplasia in association with leukoplakia and erythroplakia, which is the primary focus of this article. Oral leukoplakia has been defined in various ways, usually by the characteristics. The risk of malignant transformation may relate to patient characteristics, environmental risk factors and genetic. Biopsy and histopathologic diagnosis of oral premalignant. The volume also includes two distinct stages on the clinical direction of adrenal glands of the gynecologic tract as a well as the cytopathology of cervical precancerous lesions. We believe that the results support upfront excision or laser therapy for the management of patients with premalignant disease. Use of the carbon dioxide laser in the management of premalignant lesions of the oral mucosa volume 98 issue 12 j. Premalignant squamous lesions of the oral cavity are areas of altered epithelium that are at an increased risk for progression to squamous cell carcinoma scc. Many lesions are innocuous and can be easily diagnosed and named based upon their appearance alone. Gingivitis and destructive periodontitis with a rapid loss of the teeth were described as cardinal, pathognomic symptoms of diabetes 2,3. Premalignant lesions and conditions linkedin slideshare. Dentists look for abnormal changes that are loosely called lesions.
Lesser palatine nerves and vessels to soft palate three foramina open on the oral aspect of the hard palate page 4 premalignant and malignant lesions of oral cavity disclaimer. Premalignant conditions of oral cavity candidiasis. An investigation was undertaken to evaluate the influence of betel nut chewing on the oral. Management update of potentially premalignant oral epithelial lesions. Correlations between diabetes and inflammatory oral lesions were first published in the 19th century. Contemporary overview of premalignant lesions of the oral mucosa. Immunology of premalignant and malignant conditions of the oral cavity.
Oral cancer and precancerous lesions the oral cancer foundation. The health professional can usually identify them by patient history and clinical xamination. White lesions oral leukoplakia, a premalignant lesion. Premalignant lesions clinical medicine diseases and. Chemoprevention of premalignant and malignant lesions of.
Early evaluation of oral precancerous lesions can have dramatic effect on oral cancer mortality rate. This is a concise presentation for medical students especially from india. Precancerous lesions of oral mucosa are the diseases that have malignant transformation risk at different ratios. A routine part of an oral examination should be inspection not only of the teeth and gums but also of the soft tissues in and around the mouth. Chemoprevention of premalignant and malignant lesions of oral cavity. An overview of the normal development, anatomy and physiology of the oral cavity.
Its defined as a clinical term for a predominantly white lesion of the oral mucosa that cannot be characterized as any other definable lesion. Accurate diagnosis of premalignant or malignant oral lesions depends on the quality of the biopsy, adequate. Detailed pathogenesis, clinical signs and symptoms, diagnosis and management, all with up to date references for further reading. In early stages, histopathological findings are distinctive, but if malignant transformation occurs, identical histological features with oral carcinoma are seen. The most common type of oral cancer is oral squamous cell carcinoma oscc, which accounts 90% of all oral cancer cases. However they must be able to recognize lesions at particular risk and several features which help to assess the likelihood of malignant transformation. Oral squamous cell carcinoma oscc is a major cause of cancerassociated morbidity and mortality and may develop from oral premalignant lesions opl. Introduction cancers of the oral cavity and oropharynx represent approximately three percent of all malignancies in men and two percent of all malignancies in women.