As the field of oral pathology has evolved, the nomenclature and classification of oral mucosal diseases with a remarkable risk of malignant transformation have undergone several modifications. In 2005, the World Health Organization (WHO) introduced the concept of oral potentially malignant disorders (OPMDs) as an alternative to the terms for oral precancerous lesions and precancerous conditions. In the consensus report by the WHO Collaborating Center for Oral Cancer of 2021, OPMD is defined as "any oral mucosal abnormality that is associated with a statistically increased risk of developing oral cancer."This definition encompasses a range of conditions, in-cluding oral leukoplakia, oral submucous fibrosis, proliferative verrucous leukoplakia, oral lichen planus, and other lesions. In light of the complex etiology, unclear pathogenesis, and carcinogenesis of OPMDs, early and precise diagnosis and treatment can contribute to the secondary prevention of oral cancer. For this reason, this review, which aims to provide a basis for the precise clinical diagnosis of OPMDs, was performed. Its aim was achieved by reviewing the historical evolution and research progress of the nomenclature, classification, and histopathological diagnostic criteria of OPMDs.
Humans ; Mouth Neoplasms/diagnosis* ; Precancerous Conditions/diagnosis* ; Leukoplakia, Oral/diagnosis* ; Lichen Planus, Oral/pathology* ; Oral Submucous Fibrosis/pathology* ; Mouth Mucosa/pathology* ; World Health Organization

BACKGROUND AND OBJECTIVES: Cancer of the oral cavity is a disease of the head and neck that is difficult to treat. Periodic observation and biopsy are important for its early diagnosis once a premalignant lesion in the oral cavity is confirmed. The purpose of this study was to determine the importance of early excisional biopsy by investigating the histological features of oral leukoplakia and the rate of malignant change in the oral cavity. SUBJECTS AND METHOD: A total of 327 patients who underwent punch biopsy of oral cavity from January 2011 to December 2017 were reviewed retrospectively for the presence of initial gross lesions and for their biopsy results. The histological findings of 6 initial gross lesion groups were compared. Additional excisional biopsies were performed in the seven oral cavity subsites. RESULTS: There were 33 cases of oral leukoplakia. The punch biopsies of 3 of these cases (9.1%) showed malignancy. Additional excisional biopsies were performed in 6 cases, 4 of which were malignant (66.7%). Additional excisional biopsies of the tongue were performed in 14 cases (9.0%), 5 of which (35.7%) were malignant. The rate of atypia in leukoplakia (9.1%) was higher than in other atypia groups. Additional excisional biopsies were performed in 3 cases (100%) of atypia of leukoplakia, all of which were assessed to be malignant. CONCLUSION: For tongue leukoplakia, performing an early excisional biopsy rather than an incisional biopsy is recommendable. Moreover, additional excisional biopsies are needed when the initial biopsy is suggestive of hyperkeratosis, parakeratosis, or atypia.
Biopsy ; Early Diagnosis ; Head ; Humans ; Leukoplakia ; Leukoplakia, Oral ; Methods ; Mouth ; Neck ; Parakeratosis ; Retrospective Studies ; Tongue

OBJECTIVE: This study aimed to investigate the expression and relationship of microtubule-associated protein 1 light chain 3 (LC3) and mammalian target of rapamycin (mTOR) in normal oral mucosa, oral leukoplakia (OLK), and oral squamous cell carcinoma (OSCC). This work also analyzed the relationship between expression levels and clinical factors. This study evaluated the clinical value of LC3B and mTOR as indices to determine the carcinogenic potential of OLK. METHODS: Immunohistochemistry was used to detect the expression of LC3B and mTOR in 20 cases of normal oral mucosa, 120 cases of OLK, and 30 cases of OSCC. The clinical data of 120 patients with OLK were analyzed. The relationships between expression levels and clinical factors were investigated. RESULTS: In normal oral mucosa, OLK and OSCC, the positive rates of LC3B expression were 85.0%, 65.8% and 33.3% (P<0.05), whereas the positive rates of mTOR expression were 20.0%, 48.3% and 76.7% (P<0.05). The expression levels of LC3B and mTOR were correlated and related to clinical typing of OLK (P<0.05). CONCLUSIONS LC3B and mTOR can be used as molecular biomarkers for early detection of OLK.
Biomarkers, Tumor ; metabolism ; Carcinoma, Squamous Cell ; diagnosis ; metabolism ; Humans ; Leukoplakia, Oral ; diagnosis ; metabolism ; Microtubule-Associated Proteins ; metabolism ; Mouth Mucosa ; Mouth Neoplasms ; diagnosis ; metabolism ; TOR Serine-Threonine Kinases ; metabolism

OBJECTIVES: Acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). People with AIDS are much more vulnerable to infections, including opportunistic infections and tumors, than people with a healthy immune system. The objective of this study was to correlate oral lesions associated with HIV/AIDS and immunosuppression levels by measuring clusters of differentiation 4 (CD4) cell counts among patients living in the middle western regions of Ghana. MATERIALS AND METHODS: A total of 120 patients who visited the HIV clinic at the Komfo Anokye Teaching Hospital and the Regional Hospital Sunyani of Ghana were consecutively enrolled in this prospective and cross-sectional study. Referred patients' baseline CD4 counts were obtained from medical records and each patient received an initial physician assessment. Intraoral diagnoses were based on the classification and diagnostic criteria of the EEC Clearinghouse, 1993. After the initial assessment, extra- and intraoral tissues from each enrolled patient were examined. Data analyses were carried out using simple proportions, frequencies and chi-square tests of significance. RESULTS: Our study included 120 patients, and was comprised of 42 (35.0%) males and 78 (65.0%) females, ranging in age from 21 to 67 years with sex-specific mean ages of 39.31 years (males) and 39.28 years (females). Patient CD4 count values ranged from 3 to 985 cells/mL with a mean baseline CD4 count of 291.29 cells/mL for males and 325.92 cells/mL for females. The mean baseline CD4 count for the entire sample was 313.80 cells/mL. Of the 120 patients we examined, 99 (82.5%) were observed to have at least one HIV-associated intraoral lesion while 21 (17.5%) had no intraoral lesions. Oral candidiasis, periodontitis, melanotic hyperpigmentation, gingivitis and xerostomia were the most common oral lesions. CONCLUSION: From a total of nine oral lesions, six lesions that included oral candidiasis, periodontitis, melanotic hyperpigmentation, gingivitis, xerostomia and oral hairy leukoplakia were significantly correlated with declining CD4 counts.
Acquired Immunodeficiency Syndrome ; Candidiasis, Oral ; CD4 Lymphocyte Count* ; Cell Count ; Classification ; Cross-Sectional Studies ; Diagnosis ; European Union ; Female ; Ghana* ; Gingivitis ; HIV ; Hospitals, Teaching ; Humans ; Hyperpigmentation ; Immune System ; Immunosuppression ; Leukoplakia, Hairy ; Male ; Medical Records ; Opportunistic Infections ; Oral Manifestations* ; Periodontitis ; Prospective Studies ; Statistics as Topic ; Xerostomia

Humans ; Leukoplakia, Oral ; diagnosis ; Mouth Diseases ; diagnosis

Optical spectroscopy devices are being developed and tested for the screening and diagnosis of oral precancer and cancer lesions. This study reports a device that uses white light for detection of suspicious lesions and green-amber light at 545 nm that detect tissue vascularity on patients with several suspicious oral lesions. The clinical grading of vascularity was compared to the histological grading of the biopsied lesions using specific biomarkers. Such a device, in the hands of dentists and other health professionals, could greatly increase the number of oral cancerous lesions detected in early phase. The purpose of this study is to correlate the clinical grading of tissue vascularity in several oral suspicious lesions using the Identafi(®) system with the histological grading of the biopsied lesions using specific vascular markers. Twenty-one patients with various oral lesions were enrolled in the study. The lesions were visualized using Identafi(®) device with white light illumination, followed by visualization of tissue autofluorescence and tissue reflectance. Tissue biopsied was obtained from the all lesions and both histopathological and immunohistochemical studies using a vascular endothelial biomarker (CD34) were performed on these tissue samples. The clinical vascular grading using the green-amber light at 545 nm and the expression pattern and intensity of staining for CD34 in the different biopsies varied depending on lesions, grading ranged from 1 to 3. The increase in vascularity was observed in abnormal tissues when compared to normal mucosa, but this increase was not limited to carcinoma only as hyperkeratosis and other oral diseases, such as lichen planus, also showed increase in vascularity. Optical spectroscopy is a promising technology for the detection of oral mucosal abnormalities; however, further investigations with a larger population group is required to evaluate the usefulness of these devices in differentiating benign lesions from potentially malignant lesions.
Adult ; Aged ; Aged, 80 and over ; Antigens, CD34 ; analysis ; Biomarkers, Tumor ; analysis ; Biopsy ; methods ; Carcinoma, Squamous Cell ; blood supply ; diagnosis ; pathology ; Erythroplasia ; diagnosis ; pathology ; Female ; Humans ; Immunohistochemistry ; Leukoplakia, Oral ; blood supply ; diagnosis ; pathology ; Lichen Planus, Oral ; diagnosis ; pathology ; Male ; Middle Aged ; Mouth Neoplasms ; blood supply ; diagnosis ; pathology ; Neoplasm Grading ; Optical Imaging ; methods ; Pilot Projects ; Precancerous Conditions ; blood supply ; diagnosis ; pathology ; Spectrometry, Fluorescence ; methods ; Young Adult

Oral cancer has a tendency to be detected at late stage which is detrimental to the patients because of its high mortality and morbidity rates. Early detection of oral cancer is therefore important to reduce the burden of this devastating disease. In this review article, the most common oral precancerous lesions are discussed and the importance of early diagnosis is emphasized. In addition, the most common non-invasive oral cancer devices that can aid the general practitioners in early diagnosis are also discussed.
Cell Transformation, Neoplastic ; classification ; Coloring Agents ; Early Detection of Cancer ; instrumentation ; methods ; Fluorescence ; Humans ; Leukoplakia, Oral ; diagnosis ; Luminescence ; Mouth Neoplasms ; diagnosis ; Precancerous Conditions ; diagnosis

Erythroplasia ; diagnosis ; epidemiology ; therapy ; Humans ; Leukoplakia, Oral ; diagnosis ; epidemiology ; therapy ; Mouth Mucosa ; pathology

Oral leukoplakia is the most common premalignant lesion and malignant transformation has been reported from verrucal lekoplakia. Homogenous, benign leukoplakia develops into a line of squamous cell carcinoma such as verrrucous carcinoma, papillary squamous cell carcinoma and invasive squamous cell carcinoma. Early diagnosis and intervention of premalignant leukoplakia is up-most important to prevent transformation into a oral squamous cell carcinoma. Any change in surface, size and color warrants repeated biopsy. If verrucous carcinoma is evidently derived from the previous leukoplakia, wide surgical excision and periodic follow up is needed. Surgically removed lesion of leukoplakia has the tendency to recur. Follow-up is very important to patient and clinician. Although many therapies have been reported to oral leukoplakia and verrucal carcinoma, accepted treatment principle is not exist so far. But surgical removal is recommended as the treatment of choice.]]>
Biopsy ; Carcinoma, Papillary ; Carcinoma, Squamous Cell ; Carcinoma, Verrucous ; Early Diagnosis ; Follow-Up Studies ; Humans ; Leukoplakia ; Leukoplakia, Oral

Humans ; Leukoplakia, Oral ; diagnosis ; therapy ; Lichen Planus, Oral ; diagnosis ; therapy ; Mouth Neoplasms ; prevention & control ; Oral Submucous Fibrosis ; diagnosis ; therapy ; Precancerous Conditions ; diagnosis ; therapy