Precursor Lesions of the Oral Cavity Cancer

  • There is a sequence of disease progression from:
    • Atypia / dysplasia, to in situ carcinoma, to invasive cancer
  • Leukoplakia and erythroplakia:
    • Are terms given to clinically identifiable lesions:
      • That may harbor invasive cancer or undergo malignant transformation
  • Precursor lesions may present as:
    • Small patches or as a large verrucous plaques
    • The surface can be:
      • Brown to red (erythroplakia) or may have circumscribed whitish plaques (leukoplakia)
      • White spots may ulcerate
  • Leukoplakia:
    • Develops as a result of chronic irritation of the mucous membranes by carcinogens
      • This irritation stimulates proliferation of epithelial and connective tissue
    • Histopathologic examination reveals:
      • Underlying hyperkeratosis associated with epithelial hyperplasia
    • In the absence of underlying dysplasia:
      • Leukoplakia rarely (less than 5 %) is associated with progression to malignancy (Ridge, 2013; Massano et al., 2006; Thompson, 2003)
  • Erythroplakia:
    • Red spots, friable adjacent normal mucosa:
      • Characterize erythroplakia
    • It is associated with underlying epithelial dysplasia and has a much greater potential for malignancy than leukoplakia:
      • Carcinoma is found in nearly 40 % of the cases of erythroplakia (Ridge, 2013)
  • The classification of the world health organization (WHO) of precursor lesions is as follows (Barnes, 2005):
    • Squamous cell hyperplasia:
      • Hyperplasia describes an increase in the number of cells:
        • This can be in the spinous layer (acanthosis), and / or in the layers of basal / parabasal cells (progenitor compartment) called basal cell hyperplasia
    • Dysplasia:
      • Is characterized by cellular atypia, loss of normal cellular maturation, and loss of epithelial stratification:
        • Mild dysplasia:
          • Squamous intraepithelial neoplasia 1
        • Moderate dysplasia:
          • Squamous intraepithelial neoplasia 2
        • Severe dysplasia or carcinoma in situ:
          • Squamous intraepithelial neoplasia 3
      • The probability of developing a carcinoma depends on the degree of dysplasia:
        • In the case of severe dysplasia:
          • In the case of severe dysplasia:
            • Up to 24% of patients may have an occult invasive squamous cell cancer (Ridge, 2013)
Leukoplakia on the Right and Erythroplakia

#Arrangoiz #CancerSurgeon #HeadandNeckSurgeon #SurgicalOncologist #TongueCancer #SCC #Miami #Mexico #MountSinaiMedicalCenter #MSMC

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