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Premalignant lesions of the oral mucosa.

The term premalignant lesion is defined and an explanation of the logical use of the term leukoplakia is given. The more common premalignant lesions of the mouth are described. Known and suspected aetiological factors in the development of oral carcinoma are discussed. It is emphasised that oral squamous cell carcinoma is, very largely a preventable disease. Signs of premalignancy in the mucosa can usually be detected clinically and remedial action at an early stage is generally effective in eliminating the lesions and avoiding their recurrence.

Adult↗

Immunohistochemical characterization of plasma cells in Zoon's balanoposthitis and (pre)malignant skin lesions.

A retrospective study in 9 patients with Zoon's balanoposthitis was done to determine the immunoglobulin class distribution in the plasma cellular infiltrate. This was carried out on paraffin-embedded specimens using an unlabelled antibody peroxidase-antiperoxidase method. In all lesions IgG-producing plasma cells predominated. IgA- and IgD-positive cells were also present in about equal quantities but fewer than IgG. IgM-positive cells were either absent or present in very low numbers. Especially in erosive lesions a high number of plasma cells was noticed. The kappa/lambda ratio was variable with a preference for lambda in 5 of 8 cases. These findings are suggestive of a nonspecific polyclonal stimulation of B cells, which might be caused by a persistent infection. The above-mentioned findings were compared with premalignant and malignant skin lesions in which a major amount of plasma cells was present in the inflammatory infiltrate. Comparable results were obtained with slight variations. The role of plasma cells in these infiltrates is discussed.

Adult↗

Erythroplakia of Queyrat of the oral mucosa. A report of 2 cases.

2 cases of erythroplakia of Queyrat of the oral mucosa are presented. In both cases the disease presented as the clinical variety of erythroplakia known as "speckled erythroplakia'. In both cases invasive squamous cell carcinoma developed and was fatal in one. The histologic features which support the view that erythroplakia of Queyrat is a different entity from Bowen's disease are emphasized.

Adult↗

Gross genomic aberrations in precancers: clinical implications of a long-term follow-up study in oral erythroplakias.

PURPOSE: Gross genomic aberrations are increasingly seen as a cause rather than a consequence of carcinogenesis. Carcinomas may be prevented by systemically acting agents when used in high-risk individuals. If gross genomic aberrations could be shown to be predictive markers in precancers, they could serve as a tool for identifying high-risk individuals to be included in chemopreventive trials. PATIENTS AND METHODS: To investigate the predictive power of gross genomic aberrations in several types of oral premalignancies, we analyzed 57 biopsies from oral erythroplakias of 37 patients, both histologically and for DNA content. DNA content was measured by high-resolution image cytometry, and distribution histograms of DNA content were generated and interpreted according to established protocols. The primary end point was cancer-free survival. RESULTS: Fifty-seven dysplastic oral red lesions from 37 patients were investigated. Forty-one lesions from 25 patients were classified with aberrant DNA content (DNA aneuploidy), of which 23 patients (92%) later developed an oral carcinoma (after a median observation time of 53 months; range, 29 to 79 months). Of 12 patients having altogether 16 lesions with normal DNA content, none developed a carcinoma (median observation time, 98 months; range, 23 to 163 months; P <.001). In multivariate analysis, DNA content was a significant prognostic factor (P <.001), whereas histologic grade, sex, use of tobacco, size and location of lesions, and the presence multiple of lesions were not. CONCLUSION: Gross genomic aberrations are highly predictive for the subsequent occurrence of carcinomas from a wide range of oral premalignancies.

Aged↗

Update on precancerous lesions.

Oral cancer continues to be a serious problem in the UK and it is well known that prevention and early recognition of potentially malignant lesions will provide the best prognosis. This article discusses recent changes in the nomenclature of lesions and current concepts in diagnosis and management.

Carcinoma, Squamous Cell↗

Oral mucosal lesions found in smokeless tobacco users.

The risk for oral mucosal lesions associated with use of smokeless tobacco among 1,109 professional baseball players during spring training in 1988 was investigated. Leukoplakia was very strongly associated with use of smokeless tobacco in this population of healthy young men. Of the 423 current smokeless tobacco users, 196 had leukoplakia compared to seven of the 493 nonusers (OR = 60.0, 95% CI = 40.5-88.8). The amount of smokeless tobacco used (in hours per day that smokeless tobacco was held in the mouth), recency of smokeless tobacco use (hours since last use), type (snuff versus chewing tobacco), and brand of snuff used were significantly associated with risk for leukoplakic lesions among smokeless tobacco users. Ninety-eight leukoplakic areas in 92 subjects were biopsied and examined microscopically. All lesions were benign, but one specimen had mild epithelial dysplasia. The long-term significance of leukoplakia in smokeless tobacco users and their relation to oral cancer is not clear.

Adult↗

Punch biopsy.

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Biopsy↗

Chemoprevention as a form of cancer control.

Once considered a futuristic concept, chemoprevention for pre-malignant oral leukoplakia lesions is now a reality. Oral leukoplakia can proceed to invasive disease and expose the upper aerodigestive tract to carcinoma. Risk factors, diagnosis and research in chemoprevention are discussed.

Erythroplasia↗

Oral mucosal changes and associated factors among male industrial workers with or without access to subsidized dental care.

Oral mucosal changes and associated factors were studied among male industrial workers in southern Finland. Two groups, with or without access to an employer-provided dental benefit scheme, were compared. A multiple-choice questionnaire followed by clinical examinations was completed by 325 (81%) subsidized workers and 174 (69%) controls. In both groups 52% of the subjects had some oral mucosal change, and there were no significant differences between the groups in the location distribution of the changes. Smoking was significantly associated with redness of the oral mucosa (p < 0.001), coating (p < 0.001), and leukoplakia (p < 0.01), whereas denture wearing was associated with ulcers (p < 0.05), hyperplasia (p < 0.001), and redness (p < 0.001). Among denture wearers non-acceptable dentures were significantly associated with hyperplasia (p < 0.001). The subsidized group had better dentures, although this did not significantly benefit their oral mucosal status.

Adult↗

Oral cancer and precancerous lesions.

In the United States, cancers of the oral cavity and oropharynx represent approximately three percent of all malignancies in men and two percent of all malignancies in women. The American Cancer Society estimates that 28,900 new cases of oral cancer will be diagnosed in 2002, and nearly 7,400 people will die from this disease. Over 90 percent of these tumors are squamous cell carcinomas, which arise from the oral mucosal lining. In spite of the ready accessibility of the oral cavity to direct examination, these malignancies still are often not detected until a late stage, and the survival rate for oral cancer has remained essentially unchanged over the past three decades. The purpose of this article is to review the clinical features of oral cancer and premalignant oral lesions, with an emphasis on early detection.

Carcinoma, Squamous Cell↗

[A case of erythroplakia of the palate, tongue and gingiva].

A case of a 58-year-old man with erythroplakia, which occurred in the palate, tongue and gingiva, is reported. The histological diagnosis of a biopsy specimen was carcinoma in situ. The patient was treated with irradiation (60Co, 5060 cGy) and chemotherapy (5-FU, arterial infusion, 6400 mg). The erythema completely disappeared following a 6-week therapy, and no atypical cells were histologically recognized. There were no signs suggesting recurrence or metastasis during the follow-up period of 5 months.

Combined Modality Therapy↗

[Contemporary model for treatment of erythroplakia].

In literature worldwide is still commonly used the term erosion to describe red areas within cervix around the external orifice. In such cases with negative cytology result, for cervical cancer prevention, the electrocoagulation or electro-conisation or other destructive operations are routinely used. Without colposcopy verification such management is inappropriate. The physician treats but does not know what he treats. It may be both common ectopy or regeneration zone so physiologic cervical states but it may be also CIN or even early cervical cancer, however cytologically negative. The first group of lesions is effectively diagnosed with colposcopy without additional diagnostic procedures and the CIN lesions are diagnosed in high percentage of accuracy. Not all of these lesions should be treated. In the group of colposcopically and cytologically unsuspected lesions just very extensive lesions with active mucous glands should be treated. Such lesions cause recurrent cervical inflammation. All other erythroplakia type lesions demand no treatment. The presence of ectopy around the external cervical orifice is just profitable for diagnosis of epithelial changes and cervical physiologic processes observation. All cases of abnormal colposcopy or cytology results, suspected of CIN should be treated as prevention of cervical cancer. In lower CIN grades electroresection (LEEP) is recommended, while in higher grades the cervical conisation is the appropriate mode of treatment.

Colposcopy↗