Precancerous lesions & conditions

1. Precancerous Lesions &
Conditions
Arsalan Wahid Malik

2. PRECANCEROUS LESION
• It’s a morphologically altered tissue in which cancer is
more likely to occur than in its apparently normal
counterpart
• E.g. erythroplakia

3. PRECANCEROUS CONDITIONS
• Its a generalized state associated with a significantly
increased risk of cancer developing.
• E.g. betel quid chewing

4. PRECANCEROUS LESIONS
• Leukoplakia
• Erythroplakia
• Speckled Leukoplakia
• Candidal Leukoplakia

5. LEUKOPLAKIA
• A predominantly white
lesion of the oral mucosa
that cannot be
characterized as any
other definable lesion.

6. ETIOLOGICAL FACTORS
• Idiopathic leukoplakia
• No evident etiological factor recognized
• Non- idiopathic leukoplakia
• Evident predisposing factors recognized
• Tobacco
• Infections
• Candida
• EBV

7. CLINICAL FEATURES
• Intrinsic white area
• Homogenous
• Wrinkled
• Verrucous
• Fissured
May vary from transparent and
thin to dense and thick

8. HISTOLOGICAL FEATURES
• Hyperkeratosis with or
without epithelial dysplasia
• Squamous cell carcinoma
• Dysplasia can be categorized
as mild, moderate and severe

9. ERYTHROPLAKIA
• It is relatively uncommon and
appears as a bright red patch
that is well defined from the
surrounding mucosa and has
a velvet-like surface texture

10. ERYTHROPLAKIA
• High incidence of cellular
atypia
• Atrophy of the epithelium
• Candida as primary or
secondary infection
• Biopsy is mandatory

11. SPECKLED LEUKOPLAKIA
• Variant of leukoplakia or
erythroplakia
• White nodular patches on
erythematous background
• Buccal mucosa involvement

12. SPECKLED LEUKOPLAKIA
• Presence of candida hyphae
as well as cellular atypia
• High potential of malignancy

13. CANDIDAL LEUKOPLAKIA
• Chronic hyperplastic
candidiasis
• Frequently speckled
• Irregular and nodular
appearance
• Diagnosis with Periodic acid
Schiff (PAS) reagents

14. MALIGNANT TRANSFORMATION
• 4 - 8 % in oral leukoplakias will have malignant transformation
• 15 % will regress spontaneously
• Sublingual leukoplakias have 40 % transformation potential
• Erythroplakia have greatest tendency of malignant
transformation (80 %)

15. MANAGEMENT
• Proper defining the area
• Cryosurgery
• CO2 laser
• Systemic antifungals

16. PRECANCEROUS CONDITIONS
• Most Common Conditions
• Oral Sub mucous Fibrosis (OSF)
• Sidropenic Dysphagia
• Lichen Planus
• Less Common Conditions
• Discoid lupus erythematosus
• Tertiary Syphilis

17. ORAL SUBMUCOUS FIBROSIS
• Oral submucous fibrosis
(OSF) is a condition in
which fibrous tissue is
laid down in the corium
of the oral mucosa

18. ORAL SUBMUCOUS FIBROSIS
• Small vesicle > ulcers>
epithelial atrophy
• Stiffening of oral mucosa
• Difficulty opening the
mouth
• Marbled mucosal

19. ORAL SUBMUCOUS FIBROSIS
• Induced by chewing areca nut
• particularly common in Asian communities.
• Probably a genetic predisposition for OSF
• Have an increased risk of developing oral carcinoma
• There does not seem to be any satisfactory treatment for OSF
although intralesional steroids have been used.
• Primary prevention by reducing the use of areca nut products
would appear to be the best way forward to reduce the
incidence of OSF.

20. SIDEROPENIC DYSPHAGIA
• Also called Paterson Kelley syndrome
• Affects middle aged females having
iron deficiency
• Mucosa appear shiny red and atrophic
• Oral leukoplakia and oral carcinoma
can develop

21. LICHEN PLANUS
• Erosive type has most common premalignant potential

22. ORAL CARCINOMA AND CARCINOGENESIS

23. SQUAMOUS CELL CARCINOMA
• SCC accounts for
approximately 90 % of the
head & neck tumors

24. ETIOLOGICAL FACTORS
• Tobacco use
• Alcohol consumption
• Sunlight
• Diet and nutritional status
• Chronic candida infections
• Viral infections
• Immunodeficiency

25. TOBACCO USE
•Smokable
• Associated more commonly with lung carcinoma
•Chewable
• Associated more commonly with oral cancer

26. TOBACCO USE
• Nicotine, ethanol and caffeine (frequently used)
• Betel quid
• Areca nut
• Betel leaf
• Lime
• Tobacco
• Catechu

27. ALCOHOL CONSUMPTION
• Independent risk factor for oral carcinoma
• Combined effect of alcohol and tobacco is greater
than individual effect of both

28. DIET & NUTRITIONAL STATUS
• Deficiency of vitamin A, E and C
• Lack of dietary iron
• Increased intake of red meat

29. CLINICAL FEATURES
•Persistent ulceration
•Induration
•Proliferative growth
•Sudden loosening of
teeth
•Lymph node
involvement

30. MANAGEMENT OF ORAL CA
• Surgery
• Chemotherapy
• Combination of both
• Depends on
• Patient preference
• Biological age
• General health
• Site & staging of cancer

31. RADIATION MUCOSITIS
• Progressive and generalized erythematous appearance
• Ulceration of oral mucosa
• Extreme pain
• Xerostomia
• Atrophic oral epithelium

32. MANAGEMENT
•Acute phase
• Simple non astringent mouthwash
• Anti inflammatory and antimicrobial mouthwash
• miconazol
•Log term therapy
• Artificial salivas
• Benzydamin hydrochloride mouthwash
• Fluoride Application

33. OSTEORADIONECROSIS
• Painful necrosis with sloughing of the
overlying bone
• Vascularity of bone compromised
• Non vital bone

34. ORAL COMPLICATIONS OF RADIOTHERAPY
• Early onset
• Mucositis
• Altered taste
• Xerostomia
• Secondary infections
• Demineralization of teeth
• Hypersensitivity
• Late onset
• Radiation caries
• Osteoradionecrosis
• Trismus

35. PREVENTION & MANAGEMENT
(RADIATION MUCOSITIS)
• Maintenance of oral hygiene
• Selective decontamination
• Mouthwashes
• Miconazol gel
• Topical steroids

36. PREVENTION & MANAGEMENT
(OSTEORADIONECROSIS)
• Avoid trauma to the oral mucosa
• Arrange extractions before radiotherapy
• Conserve teeth if possible
• Extractions must be under antibiotic cover
• Rinse with chlorhexidine 0.2 %
• Consider the use of hyperbaric oxygen

37. PREVENTION OF ORAL CARCINOMA
•Primary
•Advice on stop smoking and chewing
tobacco
•Advise moderation of alcohol intake
•Dietary advice

38. PREVENTION OF ORAL CARCINOMA
•Secondary
• Screen entire oral mucosa
• Recognize abnormalities
• Identify candida infection
• Refer any suspicious lesion to hospital

39. PREVENTION OF ORAL CARCINOMA
•Tertiary
• Importance of routine intra oral & extra oral
examination
• Regular review
• Dietary advice
• Low threshold for referral
• Chemoprevention