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      Oral Potentially Malignant Disorders: An Overview of More than 20 Entities

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          Abstract

          Cancer of the oral cavity accounts for approximately 3% of all malignancies diagnosed annually in 270,000 patients world-wide. Oral cancer is the 12th most common cancer in women and the 6th in men. Many oral squamous cell carcinomas develop from potentially malignant disorders (PMDs). Lack of awareness about the signs and symptoms of oralPMDs in the general population and even healthcare providers is believed to be responsible for the diagnostic delay of these entities. The aim of this article is to update and improve the knowledge of healthcare providers about oral PMDs.

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          Nomenclature and classification of potentially malignant disorders of the oral mucosa.

          S Warnakulasuriya, Newell W. Johnson, I Van der Waal (2007)
          At a workshop coordinated by the WHO Collaborating Centre for Oral Cancer and Precancer in the UK issues related to terminology, definitions and classification of oral precancer were discussed by an expert group. The consensus views of the Working Group are presented here. The term, 'potentially malignant disorders', was recommended to refer to precancer as it conveys that not all disorders described under this term may transform into cancer. Critically evaluating all definitions proposed so far for oral leukoplakia, the Working Group agreed that the term leukoplakia should be used to recognize 'white plaques of questionable risk having excluded (other) known diseases or disorders that carry no increased risk for cancer'. An outline was proposed for diagnosing oral leukoplakia that will prevent other oral white disorders being misclassified as leukoplakia. The Working Group discussed the caveats involved in the current use of terminology and classification of oral potentially malignant disorders, deficiencies of these complex systems, and how they have evolved over the past several decades. The terminology presented in this report reflects our best understanding of multi-step carcinogenesis in the oral mucosa, and aspires to engender consistency in use.
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            Prognosis of oral pre-malignant lesions: significance of clinical, histopathological, and molecular biological characteristics.

            J Reibel (2002)
            The concept of a two-step process of cancer development in the oral mucosa, i.e., the initial presence of a precursor subsequently developing into cancer, is well-established. Oral leukoplakia is the best-known precursor lesion. The evidence that oral leukoplakias are pre-malignant is mainly derived from follow-up studies showing that between < 1 and 18% of oral pre-malignant lesions will develop into oral cancer; it has been shown that certain clinical sub-types of leukoplakia are at a higher risk for malignant transformation than others. The presence of epithelial dysplasia may be even more important in predicting malignant development than the clinical characteristics. Three major problems, however, are attached to the importance of epithelial dysplasia in predicting malignant development: (1) The diagnosis is essentially subjective, (2) it seems that not all lesions exhibiting dysplasia will eventually become malignant and some may even regress, and (3) carcinoma can develop from lesions in which epithelial dysplasia was not diagnosed in previous biopsies. There is, therefore, a substantial need to improve the histologic assessment of epithelial dysplasia or, since epithelial dysplasia does not seem to be invariably associated with or even a necessary prerequisite for malignant development, it may be necessary to develop other methods for predicting the malignant potential of pre-malignant lesions. As a consequence of these problems, numerous attempts have been made to relate biological characteristics to the malignant potential of leukoplakias. Molecular biological markers have been suggested to be of value in the diagnosis and prognostic evaluation of leukoplakias. Markers of epithelial differentiation and, more recently, genomic markers could potentially be good candidates for improving the prognostic evaluation of precursors of oral cancer. As yet, one or a panel of molecular markers has not been determined that allows for a prognostic prediction of oral pre-cancer which is any more reliable than dysplasia recording. However, these new markers could be considered complementary to conventional prognostic evaluation.
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              Risk factors for squamous cell carcinoma of the oral cavity in young people--a comprehensive literature review.

              C.D Llewellyn, N.W. Johnson, K.A.A.S. Warnakulasuriya (2001)
              There have been several reports of a rising incidence of oral cancer from many parts of the world. Although it is well known that oral cancer increases with age, recent trends for a rising incidence particularly relates to cancer of the tongue and mouth in young males. This review critically examines 46 publications devoted to oral cancer in the young adult. Most studies suggest that 4-6% of oral cancers now occur at ages younger than 40 years. Several studies examining risk factors for oral cancer in the young provide evidence that many younger patients have never smoked or consumed alcohol, which are recognised risk factors in older groups, or that duration of exposure may be too short for malignant transformation to occur. Information on many aspects of aetiology for this disease in the young implicating occupational, familial risk, immune deficits and virus infection are meagre. The spectrum of genetic abnormality disclosed is similar to older patients, there is paucity of specific studies involving younger cohorts, but predisposition to genetic instability has been hypothesised as a likely cause. Conflicting evidence is also reported on the sex distribution and outcome compared with older patients. Much work is required to understand the caveats related to global demography, risk factors and their diagnostic and prognostic markers for this disease which might be considered a disease distinct from that occurring in older patients.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Dent Res Dent Clin Dent Prospects
                Journal ID (iso-abbrev): J Dent Res Dent Clin Dent Prospects
                Journal ID (publisher-id): Journal of Dental Research, Dental Clinics, Dental Prospects
                Title: Journal of Dental Research, Dental Clinics, Dental Prospects
                Publisher: Tabriz University of Medical Sciences
                ISSN (Print): 2008-210X
                ISSN (Electronic): 2008-2118
                Publication date (Print): Winter 2014
                Publication date (Electronic): 5 March 2014
                Volume: 8
                Issue: 1
                Pages: 6-14
                Affiliations
                11Associate Professor, Department of Oral and Maxillofacial Medicine, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                Author notes
                [* ]Corresponding Author; marbahar@ 123456gmail.com
                Article
                DOI: 10.5681/joddd.2014.002
                PMC ID: 4091702
                PubMed ID: 25024833
                SO-VID: 117614db-bc59-4a8c-aae3-9264e5fe942f
                Copyright © © 2014 The Authors; Tabriz University of Medical Sciences
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 License( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 6 January 2013
                Date accepted : 7 August 2013
                Categories
                Subject: Review

                ScienceOpen disciplines: Dentistry
                Keywords: precancerous conditions,oral cavity neoplasms,malignancy,leukoplakia,oral cancer
                Data availability:
                ScienceOpen disciplines: Dentistry
                Keywords: precancerous conditions, oral cavity neoplasms, malignancy, leukoplakia, oral cancer

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