Potentially Malignant Lesions PDF

Potentionally Malignant Lesions Dr. Asma Khan Assistant Professor BDC Learning objectives ❑ Identify lesions as potentionally malignant based on history and clinical findings ❑ Select appropriate inves...

Potentionally Malignant Lesions Dr. Asma Khan Assistant Professor BDC Learning objectives ❑ Identify lesions as potentionally malignant based on history and clinical findings ❑ Select appropriate investigations to confirm diagnosis ❑ List topical medications used in the treatment of dysplastic lesions  Premalignant Lesion A morphologically altered tissue in which cancer is more likely to develop than in its apparently normal counterpart  Epidemiology ❑ Oral premalignant lesions occur in roughly between 1.5% and 4.5% of the world's population ❑ Disproportionately affect men compared to women ❑ Oral premalignant lesions account for 17% to 35% of all new cases of oral cavity cancer and undergo malignant transformation between 0.7% and 2.9% annually  PML ❑ Leukoplakia ❑ Erythroplakia ❑ Chronic Hyperplastic Candidosis (candidal leukoplakia) ❑ Speckled leukoplakia ❑ Syphilitic leukoplakia ❑ Snuff dipper’s ❑ Dyskeratosis congenita  Leukoplakia ❑ A white patch or plaque that cannot be characterized clinically or histologically as any other disease ❑ A predominantly white lesion of the oral mucosa that cannot be characterized as any other definable lesion Incidence Etiology ❑ 0.2 – 4 % ❑ Idiopathic leukoplakia ❑ Predominantly in males ❑ Cigarette smoking and older age groups ❑ Tobacco ❑ The most common sites ❑ Alcohol exposure are buccal mucosa, floor of ❑ Betel nut chewing the mouth, ❑ Candida retrocommissural areas, ❑ Human papillomavirus ventral surface and sulcus (HPV) of the tongue, alveolar ❑ HIV ridge, palate ❑ HEP C Classification ❑ Homogenous ❑Non-homogenous ▪ Nodular ▪ Proliferative Verrucuous ▪ Speckled leukoplakia (erythroleukoplakia) Activity  Erythroplakia ❑ Bright red, velvety plaques which cannot be characterized clinically or pathologically as any other definable lesion ❑ Possesses a high risk of malignant transformation  Sites ▪ floor of the mouth ▪ tongue ▪ buccal mucosa ▪ retromolar pad ▪ soft palate  Speckled leukoplakia ❑ White nodular patches on an erythematous background ❑ Regarded as combination of leukoplakia and erythroplakia ❑ More frequently shows dysplasia than pure white lesions  Proliferative Verrucous Leukoplakia ❑ A multifocal white patch or plaque with rough surface projections ❑ Common in older age, women and non-smokers ❑ Very high risk of transformation  Candidal leukoplakia ❑ Characterized by firm, white, leathery plaques mostly on the buccal mucosa adjacent to the commissure of the lips, palate and tongue ❑ Tightly adherent and will not rubb off  Syphilitic leukoplakia ❑ Dorsum of tongue ❑ Feature of tertiary syphilis but is rarely seen now ❑ Premalignant potential is high  Snuff Dipper’s Lesion ❑ Smokeless Tobacco Keratosis ❑ Characterized by a white plaque in the buccal or labial vestibule where the tobacco is held  Dyskeratosis Congenita ❑ Classic triad of nail dystrophy, reticular skin pigmentation and oral leukoplakia (increased potential of malignant transformation)  Evaluation ❑ Early identification evolution of the length of time presence or lesion (change in of the lesion absence of pain character or size) associated recent dental bleeding dysphagia, trismus, trauma or weight loss history of smoking or alcohol exposure ❑ Special attention to medical history, including autoimmune disorders or history of solid organ transplant, is vital, as these patients are at higher risk of developing oral cavity carcinoma ❑ If the lesion is diffuse or involving multiple subsites, several samples from different sites should be obtained ❑ On physical exam, it is important to characterize size, shape, description, color, firmness, and location of the lesion, along with the presence of cervical lymphadenopathy if it is present  Treatment High-risk lesions: Prevention of oral cavity carcinoma ▪ Surgical excision (with grafting if required) with appropriate Low-risk lesions: margins is the management of choice Cessation of risk factors ▪ Laser excision including alcohol, tobacco, ▪ Laser vaporisation ▪ Photodynamic therapy and betel nut, along with ▪ Long-term follow-up close observation  Management ❑ Stop any associated habits ❑ Dietery intervention ❑ Treat candidial infection and/or iron deficiency if present ❑ Biopsy to assess dysplasia ❑ Assess risk of transformation on clinical and histological findings ❑ Consider ablation of individual lesions ❑ Maintain observation for signs of malignant change