Premalignancy 2/ oral surgery courses

Premalignant
Lesions & Conditions
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

LEARNING OBJECTIVES
At the end of the lecture student should be able to --
– Describe definition of premalignant lesions and
conditions
– Describe classification, incidence, etiology, clinical
features, histopathological features of leukoplakia
– Describe grading and histopathology of dysplasia

Definitions
• Premalignant Lesion: A morphologically altered
tissue that has more risk of undergoing malignant
transformation than its apparently normal counterpart.
– Examples: Leukoplakia, Erythroplakia, Actinic
keratosis, Palatal Keratosis associated with reverse
smoking, Carcinoma in situwww.indiandentalacademy.com

• Premalignant condition: A generalized state of
body that is more prone for cancer development.
– Examples: Oral Submucous fibrosis,
Sideropenic dysphagia, Syphilis, Discoid
lupus erythematosus, Xeroderma
pigmentosum, Lichen planus, Epidermolysis
bullosa

Leukoplakia
• Leukos- White Plakia- Patch
• Defn: A white patch or plaque more than 5 mm in its
maximum diameter which cannot be scraped off and
that cannot be characterized clinically or pathologically
as any other diagnosable disease

Classification
Homogenous
• Flat
• Corrugated
• Wrinkled
• Pumice like
Non Homogenous
• Verrucous
• Nodular
• Ulcerated
• Erythroleukoplakia

Incidence & Epidemiology
• Oral soft tissue lesions-found in 4.1% of the subjects.
• Smoker‘as melanosis-most common soft tissue lesion with
the prevalence being 1.14%.
• Stomatitis nicotina palatini (0.89%) and leukoplakia (0.59%)-the
second and third most common lesions.

Etiology
1. Smoking
2. Spirits
3. Syphilis
4. Sanguinaria
5. Sunrays
6.Sharp cusps of teeth
7.Sepsis
8.Galvanism
9.Viruses
10.Nutrition

Clinical features
• M > F
• 40 years
• Lip, buccal mucosa, tongue, gingiva, floor of the
mouth
• Early & Mild lesions appear as slightly elevated gray/
grayish white plaques which may be translucent,
fissured, wrinkled, soft and flat.
• Some authors refer this as preleukoplakia
Preleukoplakia

Clinical features
• Mild/ Thin leukoplakia may seldom show dysplasia on
biopsy may continue unchanged or regress.
• Homogenous/ Thick leukoplakia
Two thirds of the lesions slowly extend laterally,
become thicker, acquire white appearance, become
leathery, and fissure.

Clinical features
• Granular/ Nodular leukoplakia
– 1/3 regress and remaining develop increased
surface irregularities
• Verrucous/ Verruciform leukoplakia
– Some lesions show sharp or blunt projections

Proliferative Verrucous leukoplakia
• Multiple keratotic plaques with roughened surface
projections
• Slowly spread and involve other sites
• Persistent growth, eventually become exophytic and
verrucous in nature
• Most likely to transform into malignancy
• Rarely regress
• F > M 4:1 ratio, usually without habit
.

Erythroleukoplakia
• Some lesions show scattered patches of redness
• Intermixed red and white areas are called
erythroleukoplakia
• In such areas the epithelial cells are so immature or
atrophic that they can no longer produce keratin

Erythroplakia

Histopathological features
• Acanthosis
• Hyperorthokeratosis
• Hyperparakeratosis
• Dysplasia

Dysplasia diagnosing criteria
• Architecture
– Irregular epithelial stratification
– Loss of polarity of basal cells
– Basilar hyperplasia
– Increased number of mitosis
– Abnormally superficial mitosis
– Premature keratinization in single cells
(Dyskeratosis)
– Keratin pearls within rete ridges

Dysplasia diagnosing criteria
• Cytology
– Abnormal variation in nuclear size (Anisonucleosis)
– Nuclear pleomorphism (variation in nuclear shape)
– Abnormal variation in cell size (Anisocytosis)
– Cellular pleomorphism (variation in cellular shape)
– Increased nuclear cytoplasmic ratio

• Anisonucleosis: variation in size of nucleus
• Anisocytosis: variation in size of cell
• Pleomorphism: variation in shape
• Hyperchromasia: increases staining capacity of
any structure
• Hyperplasia: increase in no. of cells
• Dyskeratosis: altered keratinization

Grading of dysplasia
• Mild
Architectural disturbances
limited to lower 1/3rd

• Moderate
extending into the middle
third followed by
cytological criterion

• Severe
extending into more than
2/3rd
of epithelium and
marked cellular atypia.

Modified classification & Staging
system for Oral Leukoplakia
• L 1- Size < 2 cm
• L 2- Size 2 - 4 cm
• L 3 - Size > 4 cm
• Lx - Size not specified
• P0- No dysplasia
• P1- Distinct dysplasia
• Px- Dyaplasia not
specified
• Stage I- L1P0
• Stage II- L2P0
• Stage III- L3P0 or L1 L2
P1
• Stage IV- L3P1

Treatment
• Cessation of habit
• Vitamin A
• Surgical excision
• Electrocautery
• Cryosurgery
• Laser ablation

Summary
the definition of premalignant lesions and
conditions, classification, incidence, etiology,
clinical features, histopathological features of
leukoplakia and grading and histopathology of
dysplasia

Premalignancy 2/ oral surgery courses

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