Oral premalignant lesions

Oral premalignant lesions

1. 1 | P a g e Premalignant Lesions & Conditions


Premalignant Lesions

Idiopathic leukoplakia Candidal Leukoplakia Erythroplakia
Intro.
Definition: It's a white mucosal patch
-cannot be rubbed off
-cannot be characterized clinically as any other disease
Chronic Hyperplastic Candidiasis Definition: It's a red mucosal patch
-cannot be characterized clinically or pathologically as any other disease
-Less common & more dangerous than leukoplakia
Etiology unknown
Predisposing factors; Tobacco, Alcohol, Ultraviolet radiation, Micro-
organisms (candida albicans – treponema) & V deficiency
Not known whether candida albicans produces dysplasia OR
secondarily infects previously altered epith
Unknown
but have the same predisposing factors of oral cancer
Clinical

S&S 1- Homogenous; Definitive white smooth thin or thickened
2- Speckled; Red zones may be seen
3- Granular; finally granular in texture
4. Nodular; roughened indurated nodules
5- Verrucous; exophytic projections, sharp or blunt (rounded)
Mixed white & red thick granular plaque Red patch with fairly well defined margins
NB: focal keratotic areas may be seen
Site T (mostly), B.M, M.M

T dorsum & B.M (mostly) F,T ventral , P soft
Age Middle age & after 40ys Adult are affected 50:70 y
Sex NO NO NO
Histopathology
1. Hyperkeratosis
2. Acanthosis
3. Epithelial dysplasia (Carcinoma in situ to invasive squamous cell
carcinoma
4. Chronic inflame. Cells
1. Hyperplasia or dysplasia
2. Candidal hyphae embedded in clumps (PAS) staining
3. Monro's abcess: neutrophils infiltrating the epith. surface
forming micro abcesses
4. Chronic inf. Cells
1. Sever epith dysplasia (Carcinoma in situ to invasive squamous cell
carcinoma)
2. Epithelial atrophy
3. Epith. Lacks of keratin production (explain the red color)
4. Epithelium is thin allowing the underlying microvasculature to show
through (giving the red color)
4. Chronic inflammatory cells in C.T
X ray
NO NO NO
D.D
1. Non-specific mucositis
2. Vascular lesions
3. Candidiasis
Treatment 1. Habit Stop
2. Complete remove by surgical excision, electocautary, cryosurgery
or laser ablation
3. Follow up every 6 months for long term
some of these lesions become less extensive after antifungal
therapy
1. Remove of any suspect cause & wait for 2 weeks
2. if lesion is persist, take biopsy
3. Surgical remove with Follow up
Prognosis Malignant transformation potential
Thin seldom, Thick homogenous 1:7%
Granular & Verrucous 4:5%
Moderate 4:11%, Severe 20:35%
Malignant transformation potential: higher than idiopathic
leukoplakia (because mitotic activity is 4 times higher)
Malignant transformation potential 18:47% (80%)

2. 2 | P a g e Premalignant Lesions & Conditions


Premalignant Conditions

Smokeless Tobacco-related keratosis Oral Sebaceous Fibrosis Plummer Vinson Syndrome
Intro.
White-lesion associated with smokeless tobacco Definition: chronic progressive scaring high risk precancerous condition Paterson Kelly Syndrome
Rare disease characterized by iron deficiency anemia, glossitis &
dysphagia
Etiology Tobacco chewing & Snuff dipping Spicy food
Contributing factors: General nutrition, Vitamin deficiency, Chronic chewing
of areca (betel nut)
Iron deficiency anemia
Clinical

S&S Granular or Wrinkled white patch
-Asymptomatic
Complications:
1. Alternation in taste & Smell
2. Loss of gingival tissue, gingival recession & Periodontal diseases
3. Dental caries due to high sugar content of some strands
4. Destruction of the facial surface of alveolar bone
5. Long-term uses lead to localized wear of occlusion
Whitish yellow lesion
-Mucosa loose elasticity
-Oral burning sensation
Complications:
1. Inability to open mouth Trismus of the cheek
2. Difficulty in eating
Spoon-shaped nails
-Atrophy of the lingual papilla giving Smooth Red appearance
-Burning Sensation, Dysphagia, Fatigue, weakness & shortness of
breath
Site Mucobuccal fold (mostly) & non keratinized mucosa (F & T ventral) B.M, Retromolar area, SP soft
NB: may extend to pharynx & esophagus
T & Mucosa
Age Young adult & older than 65ys 20:40ys 30:50ys
Sex Male Female Female
Race USA, India & Southeast Asia India & Southeast Asia Scandinavian (Sweden)
Histopathology

1. Hyperkeratosis
2. Acanthosis
3. Intracellular edema may be present
4. Epithelial Dysplasia
5. Ch. Inf. Cells in C.T
6. Subepithelial fibrosis
7. Atrophy of underlying salivary glands
1. Epithelial atrophy
2. Dysplastic changes
1. Submucousal deposited of dense and vascular collagenous C. T & few
fibroblasts (Make Trismus of the cheek)
2. Chronic inflammatory cells
5. Lamina propria fibrosis; poorly vascularized & hyalinized

1. Epithelial Dysplasia
2. Epithelial Atrophy

Laboratory FiningsIron deficiency anemia
X ray
NO NO NO
D.D

Treatment 1. Stop of tobacco use, some lesions may disappear
2. Removal & microscopic examination of persists lesions

Prognosis