Oral Potentially Malignant Disorders

https://doi.org/10.1016/j.cden.2019.08.004Get rights and content

Section snippets

Key points

  • •

    Oral potentially malignant disorders are epithelial lesions that may present clinically as white (leukoplakia), red (erythroplakia), or red and white (erythroleukoplakia) patches.

  • •

    There are many factors that increase patients’ risk for developing a potentially malignant lesion.

  • •

    A biopsy of the lesion is the gold standard to differentiate between a potentially malignant lesion and other entities, and to diagnosis and grade epithelial dysplasia.

  • •

    After the diagnosis of a premalignant lesion is made,

Leukoplakia

Oral leukoplakia is the most frequently seen potentially malignant disorder in the oral cavity. Leukoplakias were first reported in the literature in 1877, when the term was applied to any white lesion occurring in the oral cavity.1 Leukoplakias are now defined as white, irreversible, and nonscrapable plaques that carry a questionable risk to transform into cancer.1, 2 More specifically, these lesions cannot be associated with any chemical, physical, or infectious causative agents except for

Erythroplakia

Erythroplakia is defined as a potentially malignant disorder of the oral cavity that presents as a red patch of the oral mucosa that cannot be diagnosed as any other definable lesion. The lesion cannot have traumatic, vascular, or inflammatory causes. Erythroplakia occurs in middle-aged and elderly patients, most commonly in the sixth and seventh decades of life. It occurs with equal frequency in both genders. Erythroplakia has a prevalence range from 0.02% to 0.83%, with a mean prevalence of

Tobacco

Smoking tobacco poses the greatest increase in risk to develop precancerous lesions in the oral cavity. Heavy cigarette smoking is the strongest predictor, with 1 study showing that smoking more than 20 cigarettes per day led to an increased risk of oral leukoplakia by 2.4 to 15 times that of nonsmokers. The cumulative effect of smoking is more important than current smoking status, which suggests that chronic long-term tobacco smoking plays a role in premalignant changes. Benzopyrene, a

Microscopic description

Because oral epithelial dysplasias (OEDs) are a precursor to malignant transformation, creating a grading system for these lesions is of utmost importance.17 Many attempts have been made to produce a grading system for oral epithelial dysplasia that is both reproducible and can serve as a reliable predictor of malignant transformation. However, assessing the degree of dysplasia in order to predict the prognosis and management of OED remains challenging. The current 2017 World Health

Treatment and management of oral premalignant lesions

Over the past 3 decades there has been little improvement in the 5-year survival rate for patients with oral cancer.24 The current 5-year survival rate has been reported to be approximately 57% (https://oralcancerfoundation.org/facts/). It is crucial that clinicians embrace the importance of early detection and treatment of premalignant lesions.

Clinical examination and biopsy are the gold standard for the detection and diagnosis of oral premalignant lesions. There are many adjunctive aids

Summary

Identifying OPMDs in the oral cavity begins with thorough clinical examination of the soft tissue in the oral cavity and assessment of the patient’s risk factors. Presence of an OPMD is confirmed via biopsy and microscopic examination of the lesional tissue. The treatment of OPMDs depends on the definitive diagnosis rendered from the biopsy specimen. Low-risk epithelial dysplasias should be closely monitored and biopsied when any changes to the lesion occur. High-risk dysplastic lesions need to

First page preview

First page preview
Click to open first page preview
View PDF

References (25)

  • P. Thomson et al.

    To treat…or not to treat? Clinicians’ views on the management of oral potentially malignant disorders

    Br J Oral Maxillofac Surg

    (2015)
  • O. Kujan et al.

    Evaluation of a new binary system of grading oral epithelial dysplasia for prediction of malignant transformation

    Oral Oncol

    (2006)

    • Cited by (29)

    • Vital staining: An inexpensive and useful diagnostic adjunct for non-healing ulcers on the lateral border of the tongue!

      2024, Oral Oncology Reports

    • Oral bacteriome and oral potentially malignant disorders: A systematic review of the associations

      2024, Archives of Oral Biology

    • American Association of Oral and Maxillofacial Surgeon's Position Paper on Oral Mucosal Dysplasia

      2023, Journal of Oral and Maxillofacial Surgery

    • A simple clinicaapproach to diagnose oral erythroplakia, the potentially malignant disorder with the highest rate of malignant development into squamous cell carcinoma!

      2022, Oral Oncology

    • Oral potentially malignant disorders: A scoping review of prognostic biomarkers

      2020, Critical Reviews in Oncology/Hematology
      Citation Excerpt :

      Despite limited evidence, the estimated malignant transformation ratio of AC is approximately 3% [14]. Usually, treatment choice for OPMD depends on the estimated risk for malignant transformation and often differs across healthcare services; for example, low-risk lesions can be treated by habit cessation and close clinical follow-up, while treatment for high-risk lesions generally involves more invasive methods (e.g., surgical excision or laser ablation) [15]. However, deciding whether to observe or actively treat an OPMD is a challenge in the daily clinical practice and, even after surgical excision, recurrence or malignant transformation might occur [16].

    • State of the Art in the Diagnosis and Assessment of Oral Malignant and Potentially Malignant Disorders: Present Insights and Future Outlook—An Overview

      2024, Bioengineering
    View all citing articles on Scopus

    Disclosure: The authors have nothing to disclose.

    1

    Co-first author.

    View full text
    © 2019 Elsevier Inc. All rights reserved.