[Erythroplakia of the mouth mucosa].
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In a cohort of 740 referred patients with oral lichen planus eight patients were found with a sharply demarcated slightly depressed erythroplakic area. The histological examination of the biopsies from the erythroplakic lesion of the 8 patients showed seven with epithelial dysplasia. In addition, two of the lesions revealed a squamous cell carcinoma. In the erythroplakic lesion without dysplasia the histological picture was found to be characteristic of lichen planus. All eight patients were seen at later follow-up examinations (median observation period: 3.6 years) and in one patient a squamous cell carcinoma arose in the erythroplakic lesion during the control period. It is concluded that the reported erythroplakic lesions in relation to oral lichen planus seem to be premalignant and they should be followed and/or treated like oral erythroplakias.
BACKGROUND: Oral potentially malignant disorders exhibit heterogeneous malignant transformation risk that clinical approaches fail to adequately predict. Histopathologic dysplasia grading, the reference standard of risk assessment, is associated with poor interobserver reliability and limited prognostic discrimination. It is necessary to define other potential patient- and tissue-associated risk modifiers to improve patient-specific disease prediction. TYPES OF STUDIES REVIEWED: PubMed was queried for patient- and specimen-derived factors as they relate to oral cancer and oral potentially malignant disorders, with preference for systematic review and meta-analysis articles published within the past 5 years. When not available, guidelines from the American Cancer Society, National Cancer Institute, or other national organizations or the most recent best articles were referenced to support the data presented. RESULTS: Within patient-associated factors, validated measures of tobacco and alcohol exposure, clinical lesion characteristics, systemic health factors including metabolic syndrome components, comorbidity risk, and dental health indexes were found. Within specimen-derived data, tissue-based analyses encompassing histopathology and advanced molecular profiling (genomic, epigenomic, transcriptomic, spatial approaches), blood-based germline and somatic mutation analysis, and saliva-based microbiome characterization and inflammatory biomarker assessment were addressed. PRACTICAL IMPLICATIONS: Malignant transformation reflects intersecting patient and specimen risk pathways that affect each patient differently; no single modality captures this complexity. Realizing precision prognostication in oral precancer will require coordinated expansion and standardization of data collection across research groups. This review is intended to guide covariate selection for prospective study design, improve reproducibility, and ultimately enable the development of validated multimodal risk prediction tools for clinical deployment.