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Öhman J, Zlotogorski-Hurvitz A, Dobriyan A, Reiter S, Vered M, Willberg J, Lajolo C, Siponen M. Oral erythroplakia and oral erythroplakia-like oral squamous cell carcinoma - what's the difference? BMC Oral Health 2023; 23:859. [PMID: 37957684 PMCID: PMC10644603 DOI: 10.1186/s12903-023-03619-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Oral erythroplakia (OE) is a rare oral potentially malignant disorder, that has a high rate of malignant transformation. The definition of OE still lacks uniformity. In particular, lesions that look clinically like erythroplakias, but are histopathologically diagnosed as squamous cell carcinomas are still sometimes called erythroplakias. The purpose of this study is to present demographic and clinicopathologic features of a series of OEs and clinically oral erythroplakia -like squamous cell carcinomas (OELSCC), to study their differences and to discuss the definition of OE. METHODS A multicenter retrospective case series of OEs and OELSCCs. Descriptive statistics were used to analyze the data. RESULTS 11 cases of OEs and 9 cases of OELSCCs were identified. The mean age of the OE patients was 71 years and 72.7% were female, while the mean age of the OELSCC patients was 69 years, and all were female. 9% of the OE and 22% of the OELSCC patients had smoked or were current smokers. 72.7% of the OEs and 55.5% of OELSCCs were uniformly red lesions. 63.6% of the OE and 22% of the OELSCC patients had a previous diagnosis of oral lichenoid disease (OLD). The malignant transformation rate of OE was 9% in a mean of 73 months. CONCLUSIONS OE and OELSCC may arise de novo or in association with OLD. Tobacco and alcohol use were not prevalent in the present cases. The clinical features of OEs and OELSCC are similar, but symptoms, uneven surface and ulceration may be more common in OELSCCs than in OEs. Clinical recognition of OE is important since it may mimic other, more innocuous red lesions of the oral mucosa. The diagnosis of OE requires biopsy and preferably an excision. Clarification of the definition of OE would aid in clinical diagnostics.
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Affiliation(s)
- Jenny Öhman
- Department of Oral Medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, Gothenburg, 40530, Sweden
- Department of Clinical Pathology and Cytology, Sahlgrenska University Hospital, Blå Stråket 5, Gothenburg, 41345, Sweden
| | - Ayelet Zlotogorski-Hurvitz
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, School of Dentistry, Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Jabotinski St 39, Petah Tikva, 49100, Israel
| | - Alex Dobriyan
- Department of Oral and Maxillofacial Surgery, The Chaim Sheba Medical Center, Derech Sheba 2, Tel Hashomer, Ramat Gan, 52621, Israel
| | - Shoshana Reiter
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, School of Dentistry, Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel
| | - Marilena Vered
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, School of Dentistry, Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel
- Institute of Pathology, The Chaim Sheba Medical Center, Derech Sheba 2, Tel Hashomer, Ramat Gan, 52621, Israel
| | - Jaana Willberg
- Department of Oral Pathology and Oral Radiology, Institute of Dentistry, Faculty of Medicine, University of Turku, University of Turku, Turku, 20014, Finland
- Department of Pathology, Turku University Hospital, P.O. Box 52, Turku, 20521, Finland
| | - Carlo Lajolo
- Head and Neck Department, School of Dentistry, "Fondazione Policlinico Universitario A. Gemelli - IRCCS", Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Rome, 00168, Italy
| | - Maria Siponen
- Institute of Dentistry, University of Eastern Finland, Kuopio Campus, P.O. Box 1627, Kuopio, 70211, Finland.
- Department of Oral and Maxillofacial Diseases and Oral Health Teaching Clinic, Kuopio University Hospital, P.O. Box 1711, Kuopio, 70211, Finland.
- Cancer and Translational Medicine Research Unit, University of Oulu, P.O. Box 8000, Oulu, 90014, Finland.
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Tilakaratne WM, Jayasooriya PR, Jayasuriya NS, De Silva RK. Oral epithelial dysplasia: Causes, quantification, prognosis, and management challenges. Periodontol 2000 2019; 80:126-147. [PMID: 31090138 DOI: 10.1111/prd.12259] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Oral epithelial dysplasia is a spectrum of architectural and cytological epithelial changes caused by accumulation of genetic changes, and is associated with an increased risk of progression to squamous cell carcinoma. It is a microscopic diagnosis of immense clinical importance. The initial reports of oral potentially malignant disorders with oral epithelial dysplasia transforming to oral cancer helped in understanding the nature of oral malignancies. Since then, clinical studies on oral potentially malignant disorders have combined microscopic findings of oral epithelial dysplasia to assess the malignant transformation potential of different grades of epithelial dysplasia. A significant amount of scientific literature has amassed on oral epithelial dysplasia relating to aspects of its diagnosis and management. However, the evidence base is weak as a result of the significant variability of published research. Poorly described study methods, variability in different oral epithelial dysplasia grading systems, inter- and intra-examiner variability causing issues of reliability, inadequate sample size, and inconsistent durations of follow-up are some of the methodological issues contributing to the failure to provide dependable information. Randomized clinical trials on the malignant transformation potential of oral epithelial dysplasia and its treatment outcomes are limited. This comprehensive literature review on oral epithelial dysplasia summarizes the scientific knowledge published in the scientific literature in English since its first description. The historical development, etiological factors, grading systems, diagnostic criteria, assessment of risk factors and prevention of malignant transformation, management principles of different grades of oral epithelial dysplasia (surgical and nonsurgical), recommendations on follow-up, and prognostic indicators are discussed in detail.
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Affiliation(s)
- Wanninayake M Tilakaratne
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Primali R Jayasooriya
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nadeena S Jayasuriya
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rohana Kumara De Silva
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Maymone MB, Greer RO, Kesecker J, Sahitya PC, Burdine LK, Cheng AD, Maymone AC, Vashi NA. Premalignant and malignant oral mucosal lesions: Clinical and pathological findings. J Am Acad Dermatol 2019; 81:59-71. [DOI: 10.1016/j.jaad.2018.09.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 01/20/2023]
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Maia HCDM, Pinto NAS, Pereira JDS, de Medeiros AMC, da Silveira ÉJD, Miguel MCDC. Potentially malignant oral lesions: clinicopathological correlations. EINSTEIN-SAO PAULO 2016; 14:35-40. [PMID: 27074232 PMCID: PMC4872915 DOI: 10.1590/s1679-45082016ao3578] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/15/2016] [Indexed: 12/02/2022] Open
Abstract
Objective To determine the incidence of potentially malignant oral lesions, and evaluate and correlate their clinical and pathological aspects. Methods The sample consisted of cases clinically diagnosed as oral leukoplakia, oral erythroplakia, erythroleukoplakia, actinic cheilitis, and oral lichen planus treated at a diagnostic center, between May 2012 and July 2013. Statistical tests were conducted adopting a significance level of 5% (p≤0.05). Results Out of 340 patients, 106 (31.2%) had potentially malignant oral lesions; and 61 of these (17.9%) were submitted to biopsy. Actinic cheilitis was the most frequent lesion (37.5%) and the lower lip was the most affected site (49.6%). Among 106 patients in the sample, 48 (45.3%) reported nicotine consumption, 35 (33%) reported alcohol intake and 34 (32.1%) sun exposure while working. When clinical and histopathological diagnoses were compared, oral erythroplakia and atypical ulcer were the lesions that exhibited greater compatibility (100% each). Conclusion In most cases, clinical and histopathological diagnoses were compatible. An association between the occurrence of erythroplakia, leukoplakia and erythroleukoplakia with smoking was observed. Similarly, an association between actinic cheilitis and sun exposure was noted. Erythroleukoplakia presented the highest malignancy grade in this study. Finally, dental surgeons should draw special attention to diagnosis of potentially malignant oral lesions, choose the best management, and control the lesions to avoid their malignant transformation.
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Abstract
This article increases awareness of the presentation, diagnosis and management of potentially malignant and malignant oral lesions and conditions and reviews the referral process.
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Affiliation(s)
- Anne M Hegarty
- Consultant and Honorary Clinical Lecturer in the Department of Oral Medicine, Charles Clifford Dental Hospital, Sheffield S10 2SZ
| | - Keith D Hunter
- Reader and Honorary Consultant in the Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, Sheffield, South Yorkshire
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Chainani-Wu N, Madden E, Cox D, Sroussi H, Epstein J, Silverman S. Toluidine blue aids in detection of dysplasia and carcinoma in suspicious oral lesions. Oral Dis 2015; 21:879-85. [PMID: 26173924 DOI: 10.1111/odi.12358] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/01/2015] [Accepted: 07/05/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Accurate clinical identification of 'higher-risk' oral premalignant lesions or 'higher-risk' areas within lesions is important. Assessment methods that predict their presence have great utility. SUBJECTS AND METHODS A cross-sectional, observational study enrolled a consecutive sample of consenting patients diagnosed with oral leukoplakia, erythroleukoplakia, or erythroplakia. Medical history, visual oral examination, ViziLite(®) examination, toluidine blue staining (TBlue(®) ), and finally a biopsy were completed in a single clinic visit. Seventy-seven of 100 examined lesions in 43 patients were biopsied. Sensitivity, specificity, and positive and negative predictive values were computed for visual examination, ViziLite(®) , and TBlue(®) using biopsy results as the gold standard. RESULTS The sensitivity of TBlue(®) in detecting high-risk lesions (carcinoma in situ or carcinoma) was 94 (71-100, P < 0.0003) and specificity 45 (32-58, P < 0.53), while for carcinoma, sensitivity was 100 (54-100, P < 0.032) and specificity 39 (28-52, P < 0.097). The results of ViziLite(®) testing either by itself or in combination with the information from toluidine blue testing revealed low sensitivity for the detection of high-risk lesions. CONCLUSIONS Clinical examination of leukoplakia, erythroplakia, or erythroleukoplakia lesions combined with toluidine blue staining may aid in the identification of severe dysplasia (carcinoma in situ) or carcinoma. This may help in determining whether, when, and where (the site within a lesion) a biopsy should be taken.
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Affiliation(s)
- N Chainani-Wu
- Private practice in oral Medicine, Mountain View, CA, USA
| | - E Madden
- Northern California Institute for Research and Education (NCIRE), San Francisco, CA, USA
| | - D Cox
- Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, CA, USA
| | - H Sroussi
- College of Dentistry at the University of Illinois in Chicago, Chicago, IL, USA
| | - J Epstein
- Cedars-Sinai Medical Center, Los Angeles, CA, USA.,City of Hope National Medical Center, Duarte, CA, USA
| | - S Silverman
- University of California, San Francisco, CA, USA
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Shirani S, Kargahi N, Razavi SM, Homayoni S. Epithelial dysplasia in oral cavity. IRANIAN JOURNAL OF MEDICAL SCIENCES 2014; 39:406-17. [PMID: 25242838 PMCID: PMC4164887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/23/2013] [Accepted: 09/01/2013] [Indexed: 11/06/2022]
Abstract
Among oral lesions, we encounter a series of malignant epithelial lesions that go through clinical and histopathologic processes in order to be diagnosed. Identifying these processes along with the etiology knowledge of these lesions is very important in prevention and early treatments. Dysplasia is the step preceding the formation of squamous cell carcinoma in lesions which have the potential to undergo dysplasia. Identification of etiological factors, clinical and histopathologic methods has been the topic of many articles. This article, reviews various articles presenting oral cavity dysplasia, new clinical methods of identifying lesions, and the immunohistochemical research which proposes various markers for providing more precise identification of such lesions. This article also briefly analyzes new treatment methods such as tissue engineering.
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Affiliation(s)
- Samaneh Shirani
- Department of Oral and Maxillofacial Pathology, Islamic Azad University of Khorasgun, Isfahan, Iran;
| | - Neda Kargahi
- Department of Oral and Maxillofacial Pathology, Isfahan University of Medical Sciences, Isfahan, Iran;
| | - Sayed Mohammad Razavi
- Department of Oral and Maxillofacial Pathology, Isfahan University of Medical Sciences, Isfahan, Iran;
| | - Solmaz Homayoni
- Department of Oral Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
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Pagin O, Santos PSDS, Del Neri NB, Gustavo de Lima H, Lara VS. The importance of a proper selection area to be biopsied in nodular leukoplakia: a case report. Acta Stomatol Croat 2014; 48:42-7. [PMID: 27688350 DOI: 10.15644/asc48/1/5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Nodular leukoplakia is a non-homogeneous type of oral leukoplakia presenting a white surface with verrucous, nodular, ulcerated or erythematous features with a greater risk of malignant transformation when compared to the homogeneous type. Common sites of involvement include lip commissures, buccal mucosa and soft palate. It is often associated with epithelial dysplasia or carcinoma and requires detailed microscopic assessment and regular follow-up. The importance of a proper selection of the area to be biopsied and the close teamwork between a dentist and oral pathologist is the basis of providing an accurate final diagnosis.
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Affiliation(s)
- Otávio Pagin
- Student at Bauru School of Dentistry, University of São Paulo, Department of Stomatology
| | | | | | - Heliton Gustavo de Lima
- Bauru School of Dentistry, University of São Paulo, Department of Stomatology, Area of Pathology
| | - Vanessa Soares Lara
- Bauru School of Dentistry, University of São Paulo, Department of Stomatology, Area of Pathology
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Prabhu SR, Wilson DF. Human papillomavirus and oral disease - emerging evidence: a review. Aust Dent J 2013; 58:2-10; quiz 125. [PMID: 23441786 DOI: 10.1111/adj.12020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2012] [Indexed: 12/15/2022]
Abstract
Human papillomavirus (HPV) infections have received considerable attention in recent years. Of the 120 or so known types of the virus, some cause a variety of benign wart-like lesions of the skin and genital and oral mucosae, whilst others are aetiologically associated with cervical and anogenital cancers. Recent epidemiologic evidence suggests that HPV may also be an independent risk factor for oropharyngeal cancer. In this context it has been suggested that HPV virus may modulate the process of carcinogenesis in some tobacco and alcohol induced oropharyngeal cancers and act as the primary oncogenic agent for inducing carcinogenesis among non-smokers. Dental practitioners have a major role in detecting all lesions of the oral mucosa caused, or possibly caused, by HPV. This paper briefly reviews the current state of knowledge of molecular and clinical aspects of HPV infections of the oral mucosa.
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Affiliation(s)
- S R Prabhu
- School of Dentistry and Health Sciences, Charles Sturt University, Orange, New South Wales.
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Meiller TF, Garber K, Scheper M. A Review of Common Oral Pathology Lesions, With a Focus on Periodontology and Implantology. J Evid Based Dent Pract 2012; 12:254-62. [DOI: 10.1016/s1532-3382(12)70049-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Pereira JDS, Carvalho MDV, Henriques ÁCG, de Queiroz Camara TH, Miguel MCDC, Freitas RDA. Epidemiology and correlation of the clinicopathological features in oral epithelial dysplasia: analysis of 173 cases. Ann Diagn Pathol 2011; 15:98-102. [DOI: 10.1016/j.anndiagpath.2010.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 08/31/2010] [Indexed: 10/18/2022]
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