Oral potentially malignant disorders: Is malignant transformation predictable and preventable?

Abstract

Leukoplakia is the most common potentially malignant disorder of the oral mucosa. The prevalence is approximately 1% while the annual malignant transformation ranges from 2% to 3%. At present, there are no reliable clinicopathological or molecular predicting factors of malignant transformation that can be used in an individual patient and such event can not truly be prevented. Furthermore, follow-up programs are of questionable value in this respect. Cessation of smoking habits may result in regression or even disappearance of the leukoplakia and will diminish the risk of cancer development either at the site of the leukoplakia or elsewhere in the mouth or the upper aerodigestive tract. The debate on the allegedly potentially malignant character of oral lichen planus is going on already for several decades. At present, there is a tendency to accept its potentially malignant behaviour, the annual malignant transformation rate amounting less than 0.5%. As in leukoplakia, there are no reliable predicting factors of malignant transformation that can be used in an individual patient and such event can not truly be prevented either. Follow-up visits, e.g twice a year, may be of some value. It is probably beyond the scope of most dentists to manage patients with these lesions in their own office. Timely referral to a specialist seems most appropriate, indeed. Key words:Oral potentially malignant disorders, oral leukoplakia, oral lichen planus.

Nuclear accumulation of β‐catenin is associated with endosomal sequestration of the destruction complex and increased activation of Rab5 in oral dysplasia

“…Potentially malignant lesions in the oral mucosa are commonly defined, on an histological basis, as oral dysplasia 1,2 and are associated with high rates of progression toward oral squamous cell carcinoma (OSCC). 3,4 Despite the relevance of these lesions, the rates of progression from oral dysplasia toward invasive cancer remain disparate, which is due, in part to the complexity of histopathological diagnosis, and, because no specific markers are available for assuring the evolution of oral dysplasia.…”

Malignant development in patients with oral potentially malignant disorders detected through nationwide screening: Outcomes of 5‐year follow‐up at a single hospital

“…The rate of malignant development reported in various studies ranges from 0.13% to 50% depending on the subtype distribution, the number of cohorts, and the corresponding treatment types. 24,25 A follow-up study of 218 patients who did not receive surgical intervention indicated that the leukoplakia localized on the tongue, had a higher degree of dysplasia, or were nonhomogeneous in appearance, with a significant risk of progression to cancer. 14 Oral leukoplakia, as the most common OPMD, is defined as a predominantly white lesion of the oral mucosa that cannot be characterized as any other definable type.…”

Oral medicine: Off-label cream use

“…[3][4][5] Actinomyces, Streptococcus and Capnocytophaga are also reported to be minimally affected by metronidazole. 6 Chronic periodontitis is caused by a mixed microbial infection making the selection of targeted antibiotic difficult to justify.…”

“…4 Patients should be carefully reviewed for such events. OLP management must also encompass its malignant potential and oral cancer development which may be in up to 3.5% of cases 5,6 with essential long-term monitoring of patients to identify and diagnose early dysplastic and malignant changes. 7 Any patient with possible OLP should be initially referred to specialists to ensure that the diagnosis is formally confirmed, appropriate treatment is provided and adequate, evidence-based information is given.…”