Precancerous lesion: a morphogically altered tissue in which cancer is more likely to occur then in normal counter part

Group of disorders of varying etiology characterized by mutagen associated, sponteneous or heriditary alterations or mutation in the genetic material od oral epithelial cells with or without clinical and histomorphological alterations that may lead to oral cancer transfomation.

Also terms as pontetially malignant lesions or pre malignant lesions.

Leukoplakia

Eythroplakia

Oral submucosa fibrosis

Oral lichen planus

Palatal lesion lesion in reverse smokers

Actinic keratosis

Oral lupus erythromatous

Dyskeratosis congenita

Xeroderma pigmentosum

Age> 40years

Tobacco use

Heavy alcohol use

Betel nut quid

Spices

Viral infection eg HPV

Autoimmune reaction

Clinical term indicating white patch or plaque of oral mucosa that cannot be rubbed off and cannot be characterized as any other disease. (WHO 1978)

A predominantly white lesion od the oral mucosa that cannot be characterized as any other definable lesion (WHO 2012)

Based on clinical type

Homogenous: smooth, regular

Non homogenous: ulcerative, verrucous, speckled, nodular

Based on etiology

Tobacco associated

Idiopathic

Based on extent

Localized

diffused

Dysplastic

Non dysplastic

Based on potential for malignant transformation

High risk sites: floor of the mouth, lateral or ventral side of the tongue, soft palate

Low risk sites: hard palate, dorsum of the tongue

Solitary or multiple white patches

lesion varies from non plapable faintly translucent white areas to a thick fissured, papillomatous or indurated lesion

Feeling of increased thickness of mucosa

Ulcearted or nodular type associated with burning sensation

Enlarged regional lymph nodes

Hyperkeratosis

Light/moderate/severe dysplasia

Carcinoma in situ

Invasive cancer

Management

Conservative: eliminate etiological factor

Chemotherapy: beta carotene, topical bleomycin, 5-fluorouracil, cisplatin

Surgical: stripping, cryotherapy,laser ablation, electrocautery

Epithelial hyperplasia without dysplasia has minimal risk for cancer development (1-5%)

17-25% display a dysplastic epithelium

Lesion on the floor of the mouth has up to 45% of dysplastic epithelium

4-17%develop to cancer

30% regress of habit is ceased

A clinical term indicating a red patch or plaque of oral mucosa that can not be rubbed off and cannot be characterized clinically or histopathologically as any other disease.

Any lesion oral mucosa that presents as a bright red velvety patch in the oral cavity that cannot be attributed to any other specific condition.

Has higher potential for malignancy transformation.

Erythroplakia exhibits a clinical appeaence of a sharply demarcated flat or depressed erythematous area of mucosa with matt appearance

Lesion has typical smooth valvety texture which is contrast to the rough, keratinized surface in leukoplakia

Occurs frequently in high risk area like floor of the mouth, ventral and lateral surface of tongue, soft palate and buccal mucosa.

Surface may show areas of ulceration or erosion indicating potential for malignant transformation.

Some lesion show area of mixed red and whitish patches

Symptoms may include discomfort, tingling and sensitivity to touch, hot beverages or spicies

Homogenous: appears as uniform, red, velvety patch without any white areas or significant surface irregularities, well defined boarders

Speckled /erythroleukoplakia: red patches with interspersed white area. White area represent leukoplakia like changes within leukoplakia patch. Higher chances of malignant transformation compared to homegenous variant.

Nodular erythroplakia: red patches with nodular or granular surface changes. Appears rough with irregular surface, nodularity can indicate more advanced degree of dysplasia or invasive carcinoma.

Ulcerative erythroplakia: areas of ulceration with red patches, ulcereation can be a sign of malignant transformation or invasive carcinoma.

Squamous epithelium with erosion

Severe epithelium dysplasia or carcinoma in situ

Prognosis

80-90% often shows epithelium dysplasia or carcinoma in situ.

~23.4% will develop into invasive carcinoma

These lesions should be biopsed.

Followup is important following diagnosis and treatment.

A chronic inflammatory disorder of unknown etiology with characteristic relapses and remissions, displaying white reticular lesions with or without atrophic, erosion and ulceration and/or plaque area.

A common chronic immunological inflammatory mucocutenous disorder the varies in appearance from keratotic ( reticular or plaque like) to erythematous and ulcerative, affecting the stratified squamous epithelium.

Etiology unclear but it has been attributed to immunological reaction.

Pathogenesis mechanism

Activation of T- cells

T- cells accumulation in superficial lamina propria

Basement membrane disruption

Intra epithelial T-cell migration

Keratinocytes apptosis

Reticular form: characterized by interlacing white striations known as wickham’s striae forming a lace like pattern. Commonly found on the buccal mucosa but tongue, gingiva and other mucosal surface maybe involved. Usually asymptomatic but sometimes discomfort is present.

Erosive form: painful erythematous areas with central ulceration, sorrounding ulceration striae may still be visible. Often affect buccal mucosa and gingiva

Atrophic form: red atrophic area with minimal ulceration but often sorrounded by fine white striae. Common on gingiva thus causing desquamative gingivitis.

Bullous form: characterized by formation of fluid filled vesicles or bullae that rapture forming erosive lesions. Less common but occur on buccal mucosa, tongue, other area.

Papular form: small white pinpoint papules that may coalesce to form larger patches, occur a any area but more on buccal mucosa and it typical asytomatic

Plaque-like form: resembles leukoplakia with white, slightly raised smooth or irregular margins. Often on dorsum of tongue and buccal mucosa. Asymptomatic..

Symptomatic: atrophic, erosive, bullous.

Asymptomatic: reticular, plaque like

Lesions are usually symmetrical/ occur bilaterally

Frequently affect buccal mucosa, tongue, gingiva, lips and palate

Extra-oral mucosal involvement: conjuctiva, oesophagus/larynx, anogenital area.

On skin flat toppef purple polygonal and pruritic papular rash

Chronic and relapsing in nature, tends to have periods of exacerbation and remission.

Gingival involment can lead to desquamative gingivitis which is characterized by reddness, swelling and peeling of gingival tissue

Overlying hyperkeratiniztaion

A bandlike layer of chronic inflammtory cells with underlying connective tissue

Liquefaction degeneration od basal cell zone

Clinical examination

Biopsy

Direct immunofluorescence

Treatment

Topical or systemic corticosteroids

Immunosuppresants

Follow up

Prognosis

Can develop to cancer tho chances of risk is low

Premalignant condition caused by long term exposure to ultraviolet radiation, UV can be in natural form from the sun or artificial example turning beds.

If not treated transform to squamous cell carcinoma.

Sun exposure

Artificial UV radiation exposure

Skin type

Age

Immunosuppresion eg organ transplant individuals

Lesions typically appear as rough crusty patches on the skin, color range from pink to red even brown

Lesion range from 2-4 mm or even several diameters, irregular in shape

Affect areas frequently exposed to sun such as the face, ears, neck, scalp, forearm, legs, lower lip

Clinical variants

Hypertrophic

Atrophic

Pigmented

Cutenous horn

Actinic cheilitis

Type of precancerous skin change that happens on the lips. It is related to uv light exposure either from the sun or artificial sources.

It is a variant of actinic keratosis.

Lips feel chapped and cracked

Skin around the lips have rough texture, feel tight, dry and flaky appearence

Laser resurfacing: removal specific areas of the skin

Cryotherapy

Chemical peel

curretege