Continuing medical education
Premalignant and malignant oral mucosal lesions: Clinical and pathological findings

https://doi.org/10.1016/j.jaad.2018.09.060Get rights and content

The second article in this continuing medical education series discusses the clinical and histopathologic features of common premalignant and malignant lesions of the oral cavity. It is imperative for dermatologists to be able to appropriately recognize suspicious lesions, determine the need to obtain a biopsy specimen, counsel, and refer patients presenting with premalignant or malignant conditions. Given the higher rates of mortality and morbidity of oral mucosal malignancies because of late diagnosis, appropriate treatment with multidisciplinary care in a timely manner is essential to patients with these neoplasms.

Section snippets

Oral leukoplakia

Key points

  1. Oral leukoplakia is a potential malignancy of the oral mucosa

  2. Oral leukoplakia can be homogeneous or nonhomogeneous, with nonhomogenous lesions having a higher risk for malignant transformation

  3. Treatment and prevention include tobacco cessation, chemoprevention, and surgical excision

Background

Oral leukoplakia (OL) is a common and potentially malignant condition of the oral mucosa1 that is characterized by a white, irreversible, nonscrapable lesion (Table I). A flow chart on the management of potentially

Erythroplakia

Key points

  1. Erythroplakia is an erythematous patch or plaque of the oral mucosal lesion

  2. It carries a high rate of malignant transformation

  3. Tobacco, alcohol use, and high-risk HPV are risk factors for the condition

Lichen planus

Key points

  1. Oral LP is a chronic, immunologically driven inflammatory disease that affects both the skin and mucous membranes

  2. The most common presentation is a lacy white reticular mucosal lesion

  3. Topical corticosteroids are considered first-line treatment

Mucoepidermoid carcinoma

Key points

  1. Mucoepidermoid carcinoma is the most common malignant salivary tumor to arise in children and young adults

  2. Tumors occur most commonly in the parotid, submandibular, and minor salivary glands

Background

Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy in adults and the most common tumor to arise in children and young adults <20 years of age.42, 43 MEC accounts for about 10% of all major salivary gland neoplasms and approximately 15% to 23% of all minor salivary gland neoplasms.44

Adenoid cystic carcinoma

Key points

  1. Adenoid cystic carcinoma is an aggressive tumor with a high recurrence rate, and is prone to distant metastasis

  2. Overall, ACC has a poor prognosis

Oral mucosal squamous cell carcinoma

Key points

  1. Oral mucosal squamous cell carcinoma accounts for >90% of all oral malignancies

  2. Treatment commonly involves wide surgical excision, neck dissection, radiation therapy, chemotherapy, or more commonly combination therapy

Oral mucosal melanoma

Key points

  1. Oral mucosal melanoma is a rare melanocytic neoplasm, with greater aggressive behavior than cutaneous melanoma

  2. The single most important prognostic factor is early diagnosis

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    Date of release: July 2019

    Expiration date: July 2022

    Funding sources: None.

    Conflicts of interest: None disclosed.

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