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PubMed1975

Erythroplakia of the oral cavity.

Erythroplakia of the oral cavity is a specific disease entity which must be differentiated from other specific or nonspecific inflammatory oral lesions, although this can only be done in most cases by biopsy. A series of 58 cases of oral erythroplakia has been retrieved from 65,354 consecutively accessioned biopsy-surgical specimens. The disease was found to have no apparent sex predilection (31 males and 27 females) and was most frequently seen during the 6th and 7th decades. The most common site of occurrence in females was the mandibular alveolar mucosa-mandibular gingiva-mandibular sulcus, whereas this was the least common site in males. The floor of the mouth was the most common site in males, followed by the retromolar area in both males and females. The histologic findings emphasized the serious nature of the disease, since 91% of the specimens were either invasive carcinoma, carcinoma in situ, or severe epithelial dysplasia.

Carcinoma↗
PubMed1978

Bowenoid papulosis of the penis.

During the past 18 months we have studied 36 biopsy specimens taken from 11 young men ranging in age from 21 to 36, each of whom had multiple, reddish to violaceous papules, some distinctly verrucoid or velvety on either or both the shaft and glans of the penis. The clinical diagnoses accompanying the biopsy specimens were lichen planus, psoriasis and condyloma acuminatum. In no instance was carcinomia in situ suggested in the differential diagnosis. Histologically, however, all specimens submitted showed indubitable changes of squamous cell carcinoma in situ.

Adult↗
PubMed2003

Risk factors for multiple oral premalignant lesions.

Oral leukoplakia, oral submucous fibrosis and erythroplakia are 3 major types of oral premalignant lesions. Multiple oral premalignant lesions may possibly develop due to field cancerization, where carcinogenic exposures can cause simultaneous genetic defects to the upper aerodigestive tract epithelium, putting the epithelium at high risk for development of premalignant lesions at different stages of carcinogenesis. There have been no epidemiological studies on risk or protective factors of the disease. A case-control study was conducted with data from the baseline screening of a randomized oral cancer screening trial in Kerala, India. A total of 115 subjects with multiple oral premalignant lesions (8-10% of oral premalignant lesions in our case series) were included: 64 subjects with oral leukoplakia and oral submucous fibrosis, 19 subjects with oral leukoplakia and erythroplakia, 22 subjects with oral submucous fibrosis and erythroplakia and 10 subjects with all 3 lesions. Individuals without oral lesions were considered controls (n=47,773). The odds ratio (OR) for ever tobacco chewers was 37.8 (95% confidence interval (CI)=16.2-88.1) when adjusted for age, sex, education, BMI, smoking, drinking and fruit/vegetable intake. Dose-response relationships were seen for the frequency (p<0.0001) and duration of tobacco chewing (p<0.0001) with the risk of multiple oral premalignant lesions. Whereas alcohol drinking may possibly be a risk factor for multiple oral premalignant lesions, smoking was not associated with the risk of multiple oral premalignant lesions (OR=0.9, 95%CI=0.5-1.7). The results suggest that tobacco chewing was the most important risk factor for multiple oral premalignant lesions and may be a major source of field cancerization on the oral epithelium in the Indian population.

Adult↗
PubMed1999

Experimental intervention study about recognition of erythroplakia by undergraduate dental students.

The aim of this study was to assess the efficacy of an examiners' training programme applied to identification of erythroplakia, which undergraduate dental students have found particularly difficult. An experimental group of 5th year undergraduate dental students received a pictorial handout with diagnostic criteria for oral red lesions and two, one hour-long diagnostic seminars in which oral erythroplakia was discussed, together with other red lesions with similar clinical appearance. Three months later a set of 16 photographic slides depicting previously pathologically diagnosed red lesions were projected. Sensitivity, specificity and agreement were all higher for the experimental group compared to a control group. It is suggested that teaching procedures using slides could be useful for training future examiners at recognizing oral erythroplakias.

Audiovisual Aids↗
PubMed1993

Premalignant lesions of the upper aerodigestive tract: pathologic classification.

Intraepithelial neoplasia of the upper aerodigestive tract (UADT), including both histologically defined dysplasia and carcinoma in situ (CIS), appears to fall into two broad groups similar to intraepithelial neoplasia of other squamous mucosae, keratinizing and non-keratinizing. Keratinizing dysplasia/CIS is common in the UADT and uncommon in other sites such as the cervix. In general, keratinizing epithelial proliferation results in thick epithelium, usually with prominent superficial keratin expression with a whitish or "leukoplakic" clinical appearance. Although most clinical leukoplakic changes in the UADT mucosa do not represent neoplastic transformation and do not progress to invasive carcinoma, keratinizing dysplasia, defined by nuclear atypism and maturation alterations, has an appreciable progression to invasive carcinoma. Non-keratinizing dysplasia/CIS, common in the cervix, is less common in the UADT mucosa. In general, non-keratinizing epithelial alterations consist of a proliferation of incompletely differentiated cells as measured by a spectrum of maturation markers. These changes result in a thin epithelium which commonly has a red, or clinically "erythroplakic," appearance. Non-keratinizing dysplasias are less common, but are more likely to harbor high grade dysplasia or early invasive carcinoma.

Animals↗
PubMed1983

Natural history and management of keratosis, atypia, carcinoma-in situ, and microinvasive cancer of the larynx.

Keratosis, atypia, carcinoma in situ, and microinvasive cancer occurring as white or red patches on the vocal cords are part of the diathesis of cancer of the aerodigestive tract and represented a sequential continuum. Excisional biopsy is the preferred treatment for identification and potential cure of the lesion. If the margins of excision are inadequate, further treatment options are either reexcision or radiotherapy. Radiotherapy should be used only when the need for voice conservation prevails. Cessation of smoking does not remove the potential for progression of the disease, therefore, all patients must be followed indefinitely. Excisional biopsy of keratosis, carcinoma in situ, and microinvasive cancer of the larynx offers an excellent prognosis for voice preservation and survival.

Adult↗
PubMed1985

A study of the clinical characteristics and treatment of oral carcinoma in situ.

Twelve patients with oral carcinoma in situ were examined to clarify the clinical features and the most suitable therapy for this lesion. Seven cases were classified clinically as the erythroplakic type, two as the leukoplakic type, and three as the mixed type. The cumulative survival rate of ten cases, excluding two cases with lesions of the soft palate, was 100% in 10 years. Of 12 lesions of oral carcinoma in situ 50% progressed into invasive carcinoma. Erythroplakic lesions of oral carcinoma in situ were more aggressive than the other two types. The most suitable therapy for this lesion is prompt surgical treatment.

Adult↗
PubMed1989

Treatment of an oral erythroplastic squamous cell carcinoma with Mohs' micrographic surgery.

In the case presented in this article, a large superficial erythroplastic oral carcinoma with vaguely delineated clinical borders and foci of invasive squamous cell carcinoma was treated with Mohs' micrographic surgery. This provided a safe, thorough, yet conservative mode of treatment. Mohs' micrographic surgery may be considered among the alternative treatments for selected mucosal lesions of squamous cell carcinoma.

Carcinoma, Squamous Cell↗
PubMed1991

Oral leukoplakia and adolescent smokeless tobacco use.

The recent increase in smokeless tobacco (ST) use has prompted investigators to assess the health effects of ST use. This study attempted to evaluate the prevalence of oral leukoplakia among adolescent users and to determine factors associated with its presence. During their annual physical examination, 1116 teenaged football players (567 black, 546 white) answered a 34-question survey and received an oral screening examination. Results indicated that 0.5% of nonusers, 1.5% of previous users, and 13% of current users had clinically evident oral leukoplakia. Factors statistically associated with higher leukoplakia rates included history of ST use, regular ST use, years of ST use, and the weekly quantity consumed. Factors not associated included use of alcohol, use of cigarettes, type of ST used, and hours of ST use. One brand of snuff was found to be associated with a relative risk of leukoplakia higher than that of another brand of snuff. Overall, in ST users oral leukoplakia was six times more likely to develop than in nonusers. Earlier ages of ST use may lead to greater periods of use (in years) and to possible increases in deleterious long-term health effects in current adolescents.

Adolescent↗
PubMed1990

Spindle-cell carcinoma: a case report.

An unusual case of an exophytic spindle-cell carcinoma of the maxilla arising from an area of erythroplakia is presented. The epithelial nature of the spindle cells was demonstrated by electron microscopy and immunohistochemistry. After initial surgery the tumour recurred and was then extensively infiltrative and rapidly destructive. Magnetic resonance imaging (MRI) revealed an invasive tumour of the contra-lateral maxillary antrum suggesting a multicentric origin.

Aged↗
PubMed1992

Expression of the tumour suppressor gene p53 in oral cancer.

In this preliminary series, the product of the tumour suppressor gene p53 was detected in 12/15 cases of oral squamous cell carcinoma (SCC) and in two cases of leukoplakia. The tumours either expressed the mutant form of p53 throughout the specimen or contained focal areas of positive cells. p53 expression was commonly observed in tumours obtained from patients who were heavy smokers and drinkers suggesting that alterations in the p53 gene may be one of the sites of genetic damage in this group of patients.

Alcohol Drinking↗
PubMed1990

Detection of human papillomavirus-genomic DNA in oral epithelial dysplasias, oral smokeless tobacco-associated leukoplakias, and epithelial malignancies.

Human papillomavirus (HPV) is an infectious agent that is increasingly associated with mucosal cancers, in particular cancer of the cervix. The present investigation was undertaken in an attempt to determine whether HPV could be easily detected in biopsies of oral tissues, specifically oral squamous cell carcinomas, oral epithelial dysplasias, smokeless tobacco keratoses, verrucous hyperplasia, and verrucous carcinoma. In situ DNA hybridization methods were used to isolate specific HPV genomes. Among 100 instances of benign leukoplakia, only 4% of non-tobacco-related and 10% of smokeless tobacco-related lesions harbored viral sequences. We were able to detect viral sequences in dysplastic lesions 3% of the time. Alternatively, 17% and 20% of the verrucous hyperplasias and verrucous carcinomas were positive for viral nucleic acids. Six percent of the squamous cell carcinomas harbored HPV. On the basis of these findings, it is concluded that HPV of known genotype can be identified in oral premalignant and malignant neoplasms.

Carcinoma in Situ↗
PubMed1992

Diagnostic significance of nuclear DNA content and nuclear area in oral hyperplasia, dysplasia, and carcinoma.

The nuclear DNA content and the nuclear area in hyperplasia, dysplasia, and carcinoma of the oral cavity were quantitatively analyzed by microspectrophotometry. In carcinoma, marked variability of the nuclear DNA content and the nuclear area was found. The mean nuclear DNA content, the variance of the nuclear DNA content, the frequency of cells above tetraploid (4 C), the mean nuclear area, and the variance of nuclear area in hyperplasia and dysplasia were significantly different from these values with carcinoma. In some cases of leukoplakia and verrucous hyperplasia with subsequent malignant formation, the values were beyond the lower limit of carcinoma. The results suggest that the nuclear DNA and the nuclear area are important objective indices for predicting malignant potential of precancerous lesions.

Carcinoma, Squamous Cell↗