Premalignant Lesions & Conditions

• 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

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

Classification
Homogenous
(Uniformly white)
• Smooth
• Furrowed (Fissured)
• Ulcerated
Non Homogenous
(White & Red lesions)
• Verrucous
• Nodular
• Ulcerated

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.

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.

Etiology
• Smoking
• Spirits
• Syphilis
• Sanguinaria
• Sunrays
• Sharp cusps of teeth
• Septicemia
• Galvanism
• Viruses
• Nutrition

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)

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.

Clinical features
• Nodular leukoplakia
– 1/3 regress and remaining develop increased surface
irregularities
• Verrucous/ Verruciform leukoplakia
– Some lesions show sharp or blunt projections

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

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