Use of the carbon dioxide laser in the management of premalignant lesions of the oral mucosa volume 98 issue 12 j. Premalignant oral lesions ontario dental association. 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. Review article an update on precancerous lesions of oral. Oral cancers are attributed to a number of causal agents including tobacco, alcohol, human papillomavirus hpv, and areca betel nut. 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. The two most important lesions are leukoplakia and erythroplakia both can occur in the same lesion, sometimes called erythroleukoplakia. Betel nut chewing, oral premalignant lesions, and the oral. Photodynamic therapy of malignant and premalignant lesions in patients with field cancerization of the oral cavity volume 107 issue 12 w. 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. The effect of retinoids on premalignant oral lesions. These lesions represent clinical rather than histological diagnoses.
Gingivitis and destructive periodontitis with a rapid loss of the teeth were described as cardinal, pathognomic symptoms of diabetes 2,3. Although betel nut chewing has been established as an independent cause of oral cancer, the mechanisms of carcinogenesis are poorly understood. Oral vestibule lies between the gums, teeth and inner lips, inner cheek. To date, the literature regarding this topic is not complete. Oral cavity proper lies behind and within the arch of teeth. Immunological and classical subtypes of oral premalignant. Pdf diagnostic techniques of oral premalignant lesions. The most common type of oral cancer is oral squamous cell carcinoma oscc, which accounts 90% of all oral cancer cases. 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.
Detailed pathogenesis, clinical signs and symptoms, diagnosis and management, all with up to date references for further reading. 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 and malignant lesions of oral cavity notes. Many lesions are innocuous and can be easily diagnosed and named based upon their appearance alone. Premalignant conditions of the oral cavity ajlobby.
Management for premalignant lesions of the oral cavity. 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. Pdf precancerous lesions of oral mucosa researchgate. Early evaluation of oral precancerous lesions can have dramatic effect on oral cancer mortality rate. Oral cavity anatomical and physiological specificities. Premalignant lesions of the oral cavity represent an important target for cancer prevention. Overexpression of egfr in oral premalignant lesions and. Oral cancer makes up 34% of all cancers worldwide and is currently the sixth most common cancer.
White lesions such as linea alba, leukoedema, and frictional keratosis are common in the oral cavity but have no propensity for malignant transformation. Contemporary overview of premalignant lesions of the oral mucosa. 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. Premalignant conditions of oral cavity free download as powerpoint presentation. Oral precancerous lesions and anatomy of oral cavity 1. Dentists look for abnormal changes that are loosely called lesions. Many oral sccs develop from premalignant conditions of the oral cavity.
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. Premalignant lesions and conditions linkedin slideshare. Surgical treatment of premalignant lesions of the oral. Biopsies of the mucosa should be at least 3 mm in diameter.
Clinically, these diseases may sometimes resemble each other. The levels were compared with that in normal controls and chronic. Examination of these cases provides an opportunity to study the relationship between genetic, morphological, and clonal progression in these fields and. In early stages, histopathological findings are distinctive, but if malignant transformation occurs, identical. Practitioners will see many oral white lesions but few carcinomas.
In this video, we are going to see about premalignant lesions of oral cavity. The pictures used in this presentation and its content has been obtained from a. The oral squamous cell carcinoma oscc is the most frequent type and comprises 90% of all malignancies of the oral cavity. Oral cavity cancer accounts for approximately 3% of all malignancies and is a significant. Its defined as a clinical term for a predominantly white lesion of the oral mucosa that cannot be characterized as any other definable lesion. Photodynamic therapy of malignant and premalignant lesions. Premalignant lesions of oral cavity for medical students. Download precancerous lesions of the gynecologic tract pdf. Premalignant lesions clinical medicine diseases and. These precancerous lesions include leukoplakia, erythroplakia, and the palatal lesions of reverse smokers. Oral leukoplakia has been defined in various ways, usually by the characteristics. Immunology of premalignant and malignant conditions of the oral cavity.
Protein expression profile of oral premalignant lesions opls. Modified from ajcc manual for staging of cancer, 1997, ed. Interest in the site of biopsy has come about in light of data demonstrating an increased prevalence of hpv16 specifically in oropharyngeal carcinomas. Aetiology of premalignant lesions including up to date knowledge on. Oral carcinogenesis proceeds through a stepwise accumulation of genetic damage over time. Leukoplakia and erythroplakia premalignant squamous. Progressive rise of c fos expression from premalignant to. Chemoprevention of premalignant and malignant lesions of oral cavity. Management update of potentially premalignant oral epithelial lesions. Chemoprevention of premalignant and malignant lesions of. Oral squamous cell carcinoma oscc is a major cause of cancerassociated morbidity and mortality and may develop from oral premalignant lesions opl.
Oral lesions appear as areas of opacification with loss of elasticity. The discovery of insulin treatment justified a close correlation between the disorder of the carbohydrate metabolism. 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. Oral cancer and precancerous lesions the oral cancer foundation. We believe that the results support upfront excision or laser therapy for the management of patients with premalignant disease. The aim of this study was to evaluate our experience utilizing various treatment modalities for oral cavity premalignant lesions. 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. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant. In early stages, histopathological findings are distinctive, but if malignant transformation occurs, identical histological features with oral carcinoma are seen.
Pindborg department of oral and maxillofaeial surgery and oral medicine, university hospital. Pdf precancerous lesions of oral mucosa, known as potentially malignant disorders in recent years. It is the sixth most common cancer, approximately 3% of the total cancer burden and results in 128,000 annual deaths globally 1,2. Quantitation of circulating immune complexes cic levels was established in patients with oral cancer and oral precancerous lesions. The word chemoprevention includes prevention of initiation, promotion, and progression of carcinogenesis to cancer. An improved molecular classification of opl may help refining prevention strategies. The first 4 categories must be ruled out before figure 1. Correlations between diabetes and inflammatory oral lesions were first published in the 19th century. The risk of malignant transformation may relate to patient characteristics, environmental risk factors and genetic. 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. We identified two main opl geneexpression subtypes, named immunological and classical, in 86 opl discovery. Various premalignant lesions, particularly red lesions and some white lesions have a potential for malignant change. Premalignant conditions of oral cavity candidiasis.
Inspect and palpate lateral borders from anterior to posterior with manual retraction. Biopsy and histopathologic diagnosis of oral premalignant and. This is a concise presentation for medical students especially from india. This lesion may be a result of a hypersensitivity reaction to dietary constituents such as betel nut, capsaicin, etc. Lesion of mucosa similar to lichen planus due to drugs lichenoid dermatitis. The incidence of oral cancer worldwide varies 218% and in india 0. Ppt premalignant oral lesions powerpoint presentation. Biopsy and histopathologic diagnosis of oral premalignant. 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. Premalignant conditions of the oral cavity head and neck cancer clinics series by peter a. Selected chemoprevention trials are discussed with a focus on.
White lesions oral leukoplakia, a premalignant lesion. The varied appearance of oral premalignant lesions and early oral cancer on the lateral aspect of the tongue. 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 results suggest that tobacco chewing was the most important risk factor for multiple oral premalignant lesions and may be a major source of. Oral cancer and precancerous lesions neville 2002 ca. 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. Abstract in the united states, cancers of the oral cavity and oropharynx represent. Premalignant changes arising in other oral lesions are uncommon. Accurate diagnosis of premalignant or malignant oral lesions depends on the quality of the biopsy, adequate. However they must be able to recognize lesions at particular risk and several features which help to assess the likelihood of malignant transformation. Precancerous lesions of oral mucosa pubmed central pmc. 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 most common of these lesions is squamous dysplasia in association with leukoplakia and erythroplakia, which is the primary focus of this article.
Precancerous lesions of oral mucosa are the diseases that have malignant transformation risk at different ratios. Realtime quantitative pcr demonstrates low prevalence of. The health professional can usually identify them by patient history and clinical xamination. 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. Precancerous lesions of the gynecologic tract pdf and provides a comprehensive outline of morphologic, immunophenotypic and molecular attributes, and patient results. Suspicious lesions should be biopsied to evaluate for dysplasia. 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. An overview of the normal development, anatomy and physiology of the oral cavity. An investigation was undertaken to evaluate the influence of betel nut chewing on the oral. For these lesions, the recommended depth is 4 or 5 mm.