Introduction the oral cavity, including the lips, is constantly exposed to a large number of potentially irritating and sensitizing substances. Accurate diagnosis of premalignant or malignant oral lesions depends on the quality of the biopsy, adequate clinical information and correct interpretation of the biopsy results. A potential mechanism for the development of multiple oral premalignant lesions is explained by the. 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.
Precancerous lesion its a morphologically altered tissue in which cancer is more likely to occur than in its apparently normal counterpart e. Stoltze a a department of periodontology and department of oral pathology and medicine, school of dentistry, faculty of health sciences, university of copenhagen, 20 norre alle, dk2200 copenhagen n, denmark. Lesions in the oral cavity and oropharynx are particularly amenable to imaging and imagingguided interventions because of the accessibility of the oral mucosal surfaces that are frequently screened by dentists during routine visits. Common precancerous conditions associated with oral cavity are leukoplakia, erythroplakia, oral submucous fibrosis, erosive lichen planus, and changes associated with sideropenic dysphagia.
Dentists look for abnormal changes that are loosely called lesions. Expression of cell cycle control proteins in normal epithelium, premalignant and malignant lesions of oral cavity author links open overlay panel satoru shintani a mariko mihara b yuji nakahara a akihisa kiyota b yoshiya ueyama b tomohiro matsumura b david t. The aim of this study was to evaluate our experience utilizing various treatment modalities for oral cavity premalignant lesions. India alone accounts for one third of the worlds oral cancer and has a high.
Oral premalignant lesions especially oral leukoplakia. Oct 29, 2016 the identification of pigmented tissue within the oral cavity may present a diagnostic dilemma for the clinician. Due to the premalignant character of these lesions, replacement of positively tested materials and follow up of these patients is advised. Many lesions are innocuous and can be easily diagnosed and named based upon their appearance alone. Differential diagnosis of white lesions of the oral cavity evaluate the mouth to see if the white lesion is single or multiple. The varied appearance of oral premalignant lesions and early oral cancer on the lateral aspect of the tongue. Advances in the diagnosis of oral premalignant and. Lesion of mucosa similar to lichen planus due to drugs lichenoid dermatitis. Evaluation of serum beta 2microglobulin in premalignant and malignant lesions of the oral cavity. Premalignant changes arising in other oral lesions are uncommon. Photodynamic therapy of malignant and premalignant lesions in patients with field cancerization of the oral cavity volume 107 issue 12 w. Pigmented lesions of the oral cavity pocket dentistry.
Reactive nodules of the oral cavity are fairly common and are a diverse group. We believe that the results support upfront excision or laser therapy for the management of patients with premalignant disease. Various premalignant lesions, particularly red lesions and some white lesions have a potential for malignant change. Dec 16, 2014 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. However they must be able to recognize lesions at particular risk and several features which help to assess the likelihood of malignant transformation. Apr 09, 2020 premalignant and malignant lesions of oral cavity notes edurev is made by best teachers of. Introduction head and neck cancers are a heterogeneous group of cancers that arise from the mucosa of the larynx, pharynx, oral cavity, nasal cavity and paranasal sinuses. Premalignant conditions and screening an update deepa r nair 1, ritesh pruthy 2, uday pawar 2, pankaj chaturvedi 1 1 department of head and neck surgical oncology, tata memorial centre, dr.
The recognition and timely treatment of potentially pre malignant conditions of the oral cavity. Clinical presentation of malignant lesions onset of symptoms of malignancies is often rapid prevalence of oral malignancies is low. The first 4 categories must be ruled out before figure 1. These include congenital or developmental conditions such as white sponge nevus, keratosis follicularis, hereditary benign intraepithelial dyskeratosis, pachyonychia congenita, and fordyce granules. Leukoplakia occurs most often in middleaged and older men and arises most frequently on the buccal mucosa, alveolar mucosa, and lower lip.
Oral cancer and precancerous lesions the oral cancer foundation. An overview of the normal development, anatomy and physiology of the oral cavity. Oral squamous cell carcinomas are preceded by clinically visible changes in oral mucosa, which are termed as premalignant lesions and conditions. Crosssectional study, oral cavity, malignant lesions, leukoplakia, tobacco chewing. Surgical treatment of premalignant lesions of the oral. There were many misbelieves about its causation and. Oral premalignant lesions were treated by surgical excision in 61 patients. It is a benign, morphologically altered tissue that has a greater than normal risk of malignant. The early development of oral cancer in betel nut chewers typically manifest as specific lesions of the oral cavity including leukoplakia, erythroplakia, and oral submucous fibrosis, the precursor lesion most strongly linked to oral cancer in betel nut chewers. Photodynamic therapy of malignant and premalignant lesions. Review article an update on precancerous lesions of oral. Oral premalignant lesions have shown a rate of progression of up to 17% within a mean period of 7 years after diagnosis. If it is single, look for local sources of irritation, such as cheek, tongue or lip biting. Oral white and red lesions leukoplakia, erythroplakia and.
Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 796. Introduction classification schemes for lesions of the oral cavity typically have used the clinical appearance of lesions to determine which are premalignant. This results in larger tumors, metastases, and poorer prognosis survival rates for oral cancers have not improved over the years. The health professional can usually identify them by patient history and clinical xamination. Oral submucous fibrosis leukoplakia erythroplakia candidiasis the term leukoplakia describes a greyish white patch or plaque found in the mucous membrane of the oral cavity. Clinical presentation of oral mucosal premalignant lesions. Potentially malignant diseases of the oral cavity, with the risk of developing into squamous cell carcinoma. 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. Leukoplakia is one of the most common premalignant lesions of the oral cavity. Epidemiological study of premalignant and malignant lesions.
Many oral sccs develop from premalignant conditions of the oral cavity. Oral submucous fibrosis small vesicle ulcers epithelial atrophy stiffening of oral mucosa. Potentially malignant lesions of the oral cavity special. The prevalence of precancerous lesions in the oral cavity is about 2. 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 see below.
Clinical and histopathological aspects of premalignant lesions. 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. In this video, we are going to see about premalignant lesions of oral cavity. Detailed pathogenesis, clinical signs and symptoms, diagnosis and management, all with up to date references for further reading. Premalignant lesions and conditions linkedin slideshare. Ppt premalignant oral lesions powerpoint presentation. A number of soft tissue lesions of the oral cavity, which present as tumor masses or ulcerations, are indeed reactive in nature and represent inflammations induced by irritation or by unknown mechanisms. Advances in research on potentially malignant lesions of the oral cavity are leading to earlier diagnosis, appropriate treatment, and enhanced followup. The most common location for a malignant tumor of the oral cavity is the anterior two thirds of the tongue. Oral squamous cell carcinoma oscc is a major cause of cancerassociated morbidity and mortality and may develop from oral premalignant lesions opl. Oral carcinogenesis proceeds through a stepwise accumulation of genetic damage over time. American journal of pharmacology and pharmacotherapeutics. This is a concise presentation for medical students especially from india.
Premalignant conditions of oral cavity free download as powerpoint presentation. Oral premalignant lesions include leukoplakia, erythroplakia, dysplastic leukoplakia, dysplastic lichenoid lesion, oral submucous fibrosis, and lichen planus figures 1 3. The traditional terminologies of premalignant lesions and premalignant conditions have been abandoned. Cancer of the oral cavity is the sixth most common malignancy reported worldwide and one with the highest mortality rate among all malignancies. Premalignant conditions of the oral cavity springerlink. This document is highly rated by students and has been viewed 606 times.
The world health organization who workshop in 2005 redefined all oral lesions with a potential for a malignant transformation to be grouped under the title potentially malignant disorders. Premalignant conditions of the gastrointestinal tract. Screening for and diagnosis of oral premalignant lesions. The clinical presentations of oral mucosal lesions are presented in table 2. White lesions caused by biting generally occur along the occlusal line. Expression of cell cycle control proteins in normal.
However, using clinical features to classify lesions is difficult because they vary in appearance and. Premalignant conditions of oral cavity candidiasis. Premalignant lesions of oral cavity for medical students. The recognition and timely treatment of potentially premalignant conditions of the oral cavity. Prognosis of oral premalignant lesions sage journals. Jun 21, 2017 high medium low risk lesions mnemonic. Due to lack of experience, detection is often delayed. We identified two main opl geneexpression subtypes, named immunological and classical, in 86 opl discovery. Figure 5 illustrates the potential value of combining. Precancerous conditions and lesions affect a variety of organ systems, including the skin, oral cavity, stomach, colon, and hematological system. Those early lesions can be biopsied and submitted for interpretation to pathologists. Aetiology of premalignant lesions including up to date knowledge on. The manifestation of mucosal pigment is variable and can range from focal to diffuse macular coloration or from a small nodular growth to a large mass.
An in vitro study mentioned that smokeless tobacco might induce inflammatory reactions through recruitment of leucocytes in the smokeless tobacco use sites 25. Premalignant lesions are leukoplakia, lichen planus in oral and cutaneous form, erythroplakia, stomatitis nicotina, and submucous fibrosis. Moreover, although differences in colour can help to differentiate among pigmented lesions, the interpretation of colour can be subjective and is in. Introduction the ability to subject histological material to genetic analysis has provided new insight into the origin of multiple preneoplastic and neoplastic lesions arising in the oral cavity. These socalled precancerous lesions may precede the development of carcinoma by months or by years.
Premalignant oral lesions 1 premalignant oral lesions. There is a paucity of reliable diagnostic methods to detect early malignancies. Modified from ajcc manual for staging of cancer, 1997, ed. White lesions such as linea alba, leukoedema, and frictional keratosis are common in the oral cavity but have no propensity for malignant transformation. Oral white and red lesions leukoplakia, erythroplakia and erythroleukoplakia is considered a premalignant lesion, even though risk of malignant change is small. Pdf differential diagnosis of oral malignant and premalignant. Pigmented lesions of the oral cavity the various lesions and should not be taken as absolute indicator of diagnosis. Dentists who encounter a change in the oral mucosa of a patient must decide whether the abnormality requires. Review article an update on precancerous lesions of oral cavity. Oral submucous fibrosis small vesicle ulcers epithelial atrophy stiffening of oral mucosa difficulty opening the mouth marbled mucosal 19. The oral cavity is continuously, been exposed to inhaled and consumed carcinogens, and thus it is the most common site for the origin of malignant epithelial neoplasms in the head and neck region. Fiftythree biopsies from the buccal mucosa, tongue, and pharynx and 34.
Homogenous lesions are characterized by uniformly flat, thin, uniformly white in colour and shows shallow cracks of the surface keratin1. Carcinoma of the oral cavity may be associated with or preceded by lesions that carry a serious risk of malignant changes. All suspicious lesions, however, should be examined by biopsy. Biopsy and histopathologic diagnosis of oral premalignant and. Transition of immunohistochemical expression of ecadherin and vimentin. The efficacy of oral brush biopsy with computerassisted. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant transformation rate. Oral squamous cell carcinoma oscc can be preceded by the appearance of lesions which have the potential either to develop into cancer, or portend the development of cancer in the oral cavity. Early detection and multidisciplinary approach to oral cancer patients. Oral white and red lesions leukoplakia, erythroplakia and erythroleukoplakia is considered a premalignant lesion. Oral cancer and precancerous lesions neville 2002 ca. In vivo raman spectroscopic identification of premalignant. Pathologists are required to recognize precursor lesions based on morphology or genetic analysis and to speculate on the premalignant potential of such lesions. Advances in the diagnosis of oral premalignant and malignant.
The role of human papillomavirus hpv in the development of oral premalignant disorders and scc continues to undergo investigation. 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. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant. Pdf cancer of the oral cavity accounts for approximately 3% of all malignancies. Precancerous lesions of oral mucosa pubmed central pmc. Apr 12, 2018 many white lesions involving the oral mucosa are benign and do not require treatment. Oral submucous fibrosis oral submucous fibrosis osf is a condition in which fibrous tissue is laid down in the corium of the oral mucosa 18. 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. Download precancerous lesions of the gynecologic tract pdf. Ernest borges marg, parel, mumbai 400 012, india 2 department of surgical oncology, tata memorial centre, dr. Photodynamic therapy of malignant and premalignant lesions in patients with. Criteria for inclusion in the study were epithelial dysplasia varying from slight to carcinoma in situ, or a nondysplastic lesion located sublingually or on the tongue. Up to 80% of patients with oral scc have used tobacco products,11 and the risk of developing malignancy is 59 times greater for smokers than nonsmokers. Immunological and classical subtypes of oral premalignant.
Early oral cancers and precancerous lesions are often subtle and asymptomatic. Hpv types 16 and 18 may be found in approximately 22% and 14% of oropharyngeal tumors,16 and a recent study demonstrated hpv dna in 17. Transition of immunohistochemical expression of ecadherin and. Longterm treatment outcome of oral premalignant lesions p. Loss of epithelial morphology and acquisition of mesenchymal characteristics. Many studies correlated dysplasia and malignancy lesions in the oral mucosa with the use of smokeless tobacco 11,16, 23 24 25. Betel nut chewing, oral premalignant lesions, and the oral. Oral premalignant lesions such as oral leukoplakia, oral submucous.
Premalignant conditions of the oral cavity head and neck cancer clinics series by peter a. Evaluation of a suspicious oral mucosal lesion canadian dental. Oct 31, 2018 oral cavity cancer accounts for approximately 3% of all malignancies and is a significant worldwide health problem. Premalignant and malignant lesions of oral cavity notes edurev.
To date, the literature regarding this topic is not complete. There are several histologically distinct lesions of the oral mucosa which are characterized as having malignant potential. Practitioners will see many oral white lesions but few carcinomas. An improved molecular classification of opl may help refining prevention strategies. Knowledge of the terminology associated with these lesions and the clinical warning signs facilitates communication between clinicians, their patients, and other specialists. Oral cavity anatomical and physiological specificities. Premalignant lesions are morphologically atypical tissue which appear abnormal when viewed under the microscope, and which are more likely to progress to cancer than normal tissue. Contemporary overview of premalignant lesions of the oral mucosa. 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.
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