PREMALIGNANT LESION of oral cavity

DEFINITIONIt was defined by WHO as the “ a

morphologically altered tissue in which cancer is more likely to occur than in its apparently normal counterpart.

ex: leukoplakia, erythroplakia carcinoma in situ

LEUKOPLAKIAOriginates from two Greek words leuko

(white) and plakia(patch)WHO defined it as whitish patch or plaque

that can not be characterized clinically or pathologically as any other disease and which is not associated with any other physical or chemical causative agent except the use of tobacco.

CLINICAL FEATURESOlder age group 50 yrs and aboveMales are affected more than femalesCommon sites are buccal mucosa, commisures and

lips.Commonly involves central zone of buccal mucosa

in molar region and along occlusal lineSite depends upon type of tobacco habitsSublingual keratosis refers to leukoplakia occurring

in floor of mouth and ventral surface of tonguePatches of leukoplakia varies from well localized

irregular to diffused and non palpable, faintly translucent white area to thick papillomatous

ETIOLOGY

Tobacco smokingAlcohol CandidiasisDiet deficiencyElectromagnetic reactionSyphillis

CLASSIFICATION

Homogeneous - uniformly white

Non-homogeneous - white and red lesions (erythroleukoplakia, speckled leukoplakia)

Verrucous leukoplakia (PVL) Nodular leukoplakia Ulcerated leukoplakia

STAGINGL1- size of leukoplakia<2cmL2- size of leukoplakia 2-4cmL3- size of leukoplakia >4cmLx- size of leukoplakia not specified

P - pathologyP0- no epithelial dysplasiaP1 - distinct epithelial dysplasiaPx - dysplasia not specified

OLEP(Oral leukoplakia)staging

Stage I –L1P0Stage II–L2P0Stage III–L3P0 or L1L2P1Stage IV-L3P1

ERYTHROPLAKIA

Also called as “Erythroplasia” It is bright red velvety or eroded plaques

which can not be characterized clinically or pathologically as due to another condition

ETIOLOGY

IdiopathicSmokingAlcohol…

CLASSIFICATION A) homogeneous erythroplakia B) erythroplakia interspersed with patches of

leukoplakia

C)granular or speckled erythroplakia

DIAGNOSIS

HISTOPATHOLOGICAL FEATURES of LEUKOPLAKIA

Keratinisation of epithelium of mucosa is increased Epithelial dysplasia and surface hyperkeratosis are hallmark of

leukoplakia Loss of polarity of basal cell layer Presence of more than one layer of cells having basaloid

appearance Increased nuclear cytoplasmic ratio Drop shaped rete process Irregular epithelial stratification Increased no. of mitosis Cellular pleomorphism Nuclear hyperchromatism Enlarged nucleoli Keratinisation of single cell or group cells

Moderate epithelial displasia

Severe epithelial displasia

HISTOPATHOLOGICAL FEATURES of ERYTHROPLAKIA

Epithelium shows lack of keratin production & often atrophic.

This epithelium thinness allows underlying microvasculature to show through causing the red color.

Connective tissue retepegs extends very high into epithelium.

TREATMENT of LEUKOPLAKIA

Surgical excisionCryosurgery,CO2 laser surgery , retinoids

and other drugs and recently photodynamic therapy.

TREATMENT of ERYTHROPLAKIA

Surgical excision.Elimination of suspected irritant.Prompt biopsy is indicated for persisting

lesion.

CARCINOMA IN SITUIt is also called as “intraepithelial carcinoma”Commonly occurring on skin but also occurs

on mucous membrane.Bowen’s disease is special form of

intraepithelial carcinoma particularly in patients who had arsenical therapy.

CLINICAL FEATURESMale predilection & elderly persons are commonly

affected Common sites are floor of mouth, tongue & lips.Clinically appears as -leukoplakia in 45% of lesion -erythroplakia in 16% of lesion -combination of both in 9% of lesion -ulcerated in 13% of lesion -white & ulcerated in 5% of lesion -red & ulcerated in 1% of lesion -unstated in 11% of lesion

HISTOPATHOLOGICAL FEATURESKeratin may or may not be present but if present

is more apt to be parakeratin than orthokeratin.Loss of orientation of cells and their polarity Sharp line of division between normal & altered

epithelium from surface down to connective tissue.

Increase in nuclear/ cytoplasmic ratio and nuclear hyperchromatism.

TREATMENT

No uniformly accepted treatment.Surgical excision of lesions, irradiation,

cauterized & expose to solid carbon dioxide.

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