Potentially Malignant Oral Lesions Flashcards
PMOL
Lesions are not malignant
it is not inevitable that OSCC will develop
risk that tumour will arise
risk difficult to evaluate
PMOL CF
White, red or both
flat, nodular, warty, elevated
large or small
single or multiple
any site but the tongue/FOM
What other red/white lesions exist?
inherited – white sponge naevus
irrational – frictional keratosis
immunological – LP/LR, LE
Infective – candida, EB virus
Iatrogenic – skin grafts
Classification PMOL
Leukoplakia
a.Homogenous - flat possibly fissured
B. Non-Homogenous - nodular, speckled
Erythroplakia
Proliferative verrucous leukoplakia believed to be a subset of non-homogenous leukoplakia
PMOL Epidemiology
Rare
middle aged, elderly
2M:1F
PMOL - OSCC
Site
Size - larger
Appearance - non-homogenous
Absence of risk factors
Dysplasia
Dysplasia
Architectural and cytological changes in epithelium that resemble closely those of cancer but without invasion of the tissues
Features of epithelial dysplasia
distorted rete peg architecture
irregular stratification
dyskeratosis
basal cell hyperplasia
loss of adherence
loss of polarity
hyperchromatism
increased N:C
Anisocytosis
Pleomorphism
Dysplasia and OSCC
Presence of dysplasia inc risk
Grade of dysplasia:
a. Mild – less than 5%
b. Moderate – 10-20%
c. Severe – 15-50%
Surgical tx options
scalpel excision
laser excision
co2 laser ablation
photodynamic therapy
cryotherapy
medical tx options
retinoids
EGFR inhibitors
COX2 antagonists
cell cycle interruption eg p53 modulators
topical anti-cancer agents e.g., Bleomycin
Adv tx
surgical tx – most abnormal tissue can be removed
medical tx – topical drug can be directed at most abnormal looking tissues with less destruction
Dis tx
local side effects - pain, infection, slow healing
systemic side effects - photodynamic therapy, systemic drugs
