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  1. Premalignant Lesions & Conditions
  2. • Premalignant Lesion: A morphologically altered tissue that has more risk of undergoing malignant transformation than its apparently normal counterpart. – Examples: Leukoplakia, Erythroplakia, Actinic keratosis, Palatal Keratosis associated with reverse smoking, Carcinoma in situ • Premalignant condition: A generalized state of body that is more prone for cancer development. – Examples: Oral Submucous fibrosis, Sideropenic dysphagia, Syphilis, Discoid lupus erythematosus, Xeroderma pigmentosum, Lichen planus, Epidermolysis bullosa
  3. Leukoplakia • Leukos- White Plakia- Patch • A predominantly white lesion of the oral mucosa that cannot be characterized clinically or pathologically as any other diagnosable disease; some oral leukoplakia will transform into cancer
  4. Classification Homogenous (Uniformly white) • Smooth • Furrowed (Fissured) • Ulcerated Non Homogenous (White & Red lesions) • Verrucous • Nodular • Ulcerated
  5. Incidence & Epidemiology • Prevalence of oral soft tissue lesions in tobacco users 4.1% • Smoker's melanosis is most common soft tissue lesion with the prevalence being 1.14%. • Stomatitis nicotina palatini (0.89%) and leukoplakia (0.59%) are the second and third most common lesions.
  6. Incidence & Epidemiology • Prevalence of all lesions is more common in men when compared to women, but for chewer's mucosa. • Among men, – Smoker's melanosis and – Stomatitis nicotina palatini – Leukoplakia • Among women – Leukoplakia – Oral Submucous Fibrosis • Majority of the lesions are found among people aged from 41 to 60 years.
  7. Etiology • Smoking • Spirits • Syphilis • Sanguinaria • Sunrays • Sharp cusps of teeth • Septicemia • Galvanism • Viruses • Nutrition
  8. Clinical features • M > F • 40 years • Lip, buccal mucosa, tongue, gingiva, floor of the mouth, • Early & Mild lesions appear as slightly elevated gray/ grayish white plaques which may be translucent, fissured, wrinkled, soft and flat. (preleukoplakia)
  9. Clinical features • Mild/ Thin leukoplakia may seldom show dysplasia on biopsy may continue unchanged or regress. • Homogenous/ Thick leukoplakia Two thirds of the lesions slowly extend laterally, become thicker, acquire white appearance, become leathery, and fissure.
  10. Clinical features • Nodular leukoplakia – 1/3 regress and remaining develop increased surface irregularities • Verrucous/ Verruciform leukoplakia – Some lesions show sharp or blunt projections
  11. Proliferative Verrucous leukoplakia • Multiple keratotic plaques with roughened surface projections • Slow spread and involve other sites • Persistent growth, eventually become exophytic and verrucous in nature. • Most likely to transform into malignancy • Rarely regress • F > M 4:1 ratio, usually without habit
  12. Erythroleukoplakia • Some lesions show scattered patches of redness • Intermixed red and white areas are called erythroleukoplakia • In such areas the epithelial cells are so immature or atrophic that they can no longer produce keratin