Oral precancerous lesions: a review.
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Cryotherapy is a simple to use, weakly invasive technique provoking only moderate complications in the treatment of certain mucosal lesions of the buccal cavity. Indications of choice for this type of treatment are angioma and papilloma. Long term follow up of patients treated for reactive keratosis or epithelioma in situ is at present insufficient to establish precise indications.
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North Americans in 2004 were projected to die from oral and pharyngeal cancer at a rate of 1.2 per hour. Oral healthcare providers can be instrumental in reducing the incidence of oral and pharyngeal premalignant and malignant lesions by identifying patients with high-risk behavior, educating their patients about the consequences of their high-risk behavior, and by early detection of premalignant and malignant conditions. The fact only 34% of the cancers of the oral cavity and larynx are localized at the time of diagnosis and evidence that at least one third of the patients diagnosed with an oral or pharyngeal malignancy have undergone oral cancer screening within the past three years suggests the current protocol for the early detection of pre-malignant or malignant changes appears to be deficient. To facilitate early diagnosis, oral healthcare providers must take into consideration the capriciousness of oral cancer and must be familiar with the availability and application of diagnostic modalities beyond conventional visual inspection and palpation of oral soft tissues. This article provides a comprehensive review of the disease for healthcare professionals.
The stepwise development of cancer of the head and neck over a period of several decades opens up a wide window of preventive intervention options. Although chemoprevention (for example with retinoids and COX-2 inhibitors) is possible, in terms of side effects and long-term outcomes it is not as successful as was hoped. Currently, natural substances, which in particular are characterized by an absence of side effects, are undergoing clinical trials.
During dental school admission interviews, applicants often mention that one of the appeals of choosing dentistry over medicine is the avoidance of life-or-death situations. Paradoxically if a dentist is a vigilant clinician, and an astute and knowledgeable diagnostician, he or she may be involved in the early detection of one of the approximately 29,370 new cases of oral cavity/oropharyngeal cancer estimated by the American Cancer Society to have occurred in the United States last year' This incidence is nearly three times the amount of estimated cervical carcinoma cases during the same time period and nearly 5000 more than the estimated new cases of thyroid cancer. Although the American Cancer Society estimates that both this past year's cases of leukemia and cutaneous melanoma occurred more often--34,810 and 59,580, respectively-oral cancer continues to represent a significant unknown, initially silent, and subsequently painful morbid disease and often relentless killer of the American public.
The value of mass oral cancer screenings has come under scrutiny, as a consequence of a lack of improvement in the long-term outcomes associated with oral carcinoma over the past several decades. However, it is generally accepted that most oral carcinomas are preceded by visible changes to the mucosa and certain high risk lesions have been identified. The responsibility to evaluate the mucosal tissues of the oral cavity clearly falls under the purview of the dentist. The dentist must clearly grasp the distinction between reactive lesions which usually change in 7 to 14 days and malignant and premalignant lesions which do not. Therefore, appropriate diagnostic procedures (i.e., biopsy of the lesion) must be implemented as a matter of course in the evaluation of any lesion that does not respond to usual therapy in 7 to 14 days.
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Mucosal dysplasia in the head and neck region is recognized to be a precancerous lesion. Between January 1983 and December 1987, a pilot study was conducted at the Manitoba Cancer Treatment and Research Foundation to determine the effects of beta-carotene and cis-retinoic acid on mucosal dysplasias. Eighteen patients were treated with a "cross-over" regimen. The overall response to treatment was 61%, with 33.3% complete responses. Patients who smoked had a significantly better response than nonsmokers. The response rate for 9 of 11 smokers was 81.2%, and 2 of 7 nonsmokers or 28.6% responded to this protocol. The beneficial effect of these drugs should be established by prospective, randomized trial in high risk populations.
The clinicopathological features of 130 cases of leukoplakia and 8 patients with erythroplakia of the oral mucosa are reviewed. Cases were selected on the basis of definitions agreed to at an international seminar. The patients with leukoplakia were predominantly men, (1.5:1), most were White (86.2%) and the peak age frequency was the 7th decade. The sites most frequently affected were the buccal mucosa (28.8%), floor of mouth (18.3%), alveolar ridge and gingivae (17.3%) and tongue (12.0%). Clinically, they were classified as homogeneous leukoplakia (70.6%), erythroleukoplakia (11.2%), verrucous leukoplakia (10.6%) and nodular leukoplakia (7.6%). There were no differences in age or site distribution between the sexes but the women tended to have more nodular and verrucous lesions. Most of the patients were smokers (71.5%). There was a highly significant sex difference (p less than 0.01) in the use of tobacco with 42.3 per cent of the women and 19.2 per cent of the men never having used tobacco. The tobacco users were significantly younger (p less than 0.05). Of the 143 lesions biopsied, 60.8 per cent showed no dysplasia, 28.0 per cent mild or moderate dysplasia, 4.2 per cent severe dysplasia/carcinoma-in-situ and 7.0 per cent verrucous or squamous carcinoma. Homogeneous leukoplakias have a very low frequency of dysplasia while in the case of the other clinical types the frequencies of dysplasia and malignancy are substantially higher reaching 33.3 per cent invasive malignancy in the case of the nodular lesions. The sites at greatest risk are the floor of the mouth, soft palate, alveolar ridge/gingivae, tongue and buccal mucosa in order of decreasing frequency.(ABSTRACT TRUNCATED AT 250 WORDS)
In the last years the excision of superficial benign and malignant penile tumors by laser surgery has been well established. Our first experience confirm the excellent cosmetic and functional results after laser surgery. Furthermore a decrease of recurrence rate was found due to laser vaporization of the adjacent tumor area. In spite of tissue damage by histological examination we were able to classify benign and malignant findings.
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