Abstract
Oral potentially malignant disorders (PMD) are recognisable mucosal conditions that
have an unpredictable risk of transformation to squamous cell carcinoma (SCC), a lethal
and deforming disease of rising incidence. Contemporary management is based on clinical
recognition of suspicious lesions and incisional biopsy to enable histopathological
assessment and grading of dysplasia, together with excision of high-risk lesions and
long-term surveillance. However, it is impossible to predict clinical outcome or risk
of malignant transformation. Our aim was to evaluate the relevance of previously identified
oral precursor lesions for the development of SCC and staging of disease. We therefore
retrospectively reviewed 1248 cases of SCC diagnosed in oral and maxillofacial surgery
units at Newcastle upon Tyne and Sunderland hospitals between 1996 and 2009. Of them,
58 identifiable precursor lesions became malignant but only 25 had been dysplastic
on initial biopsy; 19 of 33 non-dysplastic lesions exhibited lichenoid inflammation
only. SCC arose most often on the ventrolateral tongue and floor of the mouth, with
a mean transformation time of 29.2 months. Transformation time was significantly shorter
in men (p = 0.018) and those over 70 years of age (p = 0.010). Patients who consumed more than 21 units of alcohol/week and those who had
had interventional laser surgery to treat precursor lesions, had higher-staged tumours
(p = 0.048). Although retrospective, this study shows that the results of incisional biopsy
and grading of dysplasia have limited use as predictive tools, and supports the view
that cancer may arise in the absence of recognisable epithelial dysplasia. Our findings
confirm the importance of clinical vigilance and active surveillance in the management
of all patients with clinically suspicious oral lesions, irrespective of the histological
findings.
Keywords
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Article info
Publication history
Published online: September 17, 2015
Accepted:
August 28,
2015
Identification
Copyright
© 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
