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Pre-malignant lesionsof Oral cavity

Dr.SHANKHASHUBHRA GHOSH DLO,2ND YR

Stanley Medical College Chennai

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Benign lesions Solid- papilloma fibroma hemangioma granuloma torus palatinus

Cystic - retention cyst ranula dermoid

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Premalignant lesions Leukoplakia Erythroplakia Submucous fibrosis Lichen planus Laryngeal keratosis Actinic cheliosis Smooth,red tongue of Plummer-Vinson

syndrome

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Predisposing factors EIGHT -- “S” Smoking syphilis spices sharp tooth submucosal fibrosis siderophenic dysphagia sepsis spirit(alcohol)

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Leukoplakia -etiology Tobacco chewing and smoking Alcohol Local irritants Vitamin deficiency-vit A & B Endocrine disturbances Syphilis

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leukoplakia

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leukoplakia White patch in mucosa that does not

rub off & cannot be clinically identified Most are asymptomatic,only 20% show

evidence of dysplasia or carcinoma. Buccal mucosa and oral commissures

are most common sites Mostly fourth decade, male>female

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Non –homogenous leukoplakia

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Management

Proper history Prevention of cause Surgical excision of small lesion Topical chemotherapy and radiation

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Erythroplakia Red lesion that cannot be classified as

another entity. 91% shows signs of dysplasia Flat, macular, velvety appearance and

may be speckled with white spots representing foci of keratosis

Most common site-lower alveolar mucosa, gingivobuccal sulcus

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Types:-

A)Homogenous type: appears as bright red soft velvety lesions and extensive in size. commonly found-buccal mucosa and soft palate. B)Speckled type: soft red lesions,slightly elevated with irregular outline surface being granular-speckled

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Submucous fibrosis Subepithelial inflammatory response to

the irritants mainly due to betel nut chewing

Arecoline-active alkaloid found in betel nuts-stimulate fibroblasts to increase production of collagen by 150%

White fibrotic bands extending from retromolar trigone to soft palate,buccal mucosa , tongue.

It continues even after cessation of areca nut chewing

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Clinical features

The most common initial symptom-burning sensation of oral mucosa aggravated by spicy food followed by either hypersalivation or dryness of mouth

In advanced cases,the mucosa becomes tough and leathery, with numerous vertical fibrous band.

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Clinical staging

Stage1-stomatitis..vesicles,mucosal ulcers, mucosal petechie

Stage2-fibrosis in ruptured vesicles and ulcers. a)early-blanching..

b)late-vertical and circular palpable fibrous bands, trismus, blanched leathery floor of mouth, fibrotic and depigmented gingiva. Stage3-leukoplakia(>25%) and speech &

hearing deficits.

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Treatment Prescription of chewable pellets of

hydrocortisone Absteinence from alcohol,tea,coffee Submucosal inj of hydrocortisone Submucosal inj of human chorionic

gonadotropin Surgical treatment-multiple release

deep to mucosa,submucosa and fibrotic tissue & suturing the gap so created by mucosal flap obtained by tongue and Z-plasty.

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Cont….. In this procedure,multiple deep z

shaped incisions are made into fibrotic tissue and sutured in straight fashion

Pentoxifylline-vasodilating properties and increased mucosal vascularity used as adjunct therapy.

Stem cell therapy-intralesional inj of autologus bone marrow stem cell –angiogenesis of area and decreases fibrosis.

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Lichen planus

Malignant potential is matter of dispute Prudent practice to biopsy the lesion at

first visit to confirm diagnosis or monitor changes.

Lesion appear white lace like pattern in buccal mucosa.

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Relative risk factors for oral cancer

None 1%

Bettle nut Chewing 4%

Smoking only 3-6%

Bettel chewing+Tobacco chewing 15%

Bettel chewing+Smoking 25%

Bettel+Tobacco+smoking 20%

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Treatment If carcinoma-in-situ proved—excision by

CO2 or KTP532 laser Chemoprevention-beta-carotene and

retinoids as antioxidant supplements

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Thank you

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