‘ potential malignant disorders ‘

:Introduction
Oral potentially malignant disorders (OPMDs) are defined as a group of oral
mu- cosal lesions with an increased risk of malignant transformation. These
disorders include a mixture of diseases with different clinical appearance,
histological subtypes and risk factors/etiologies and comprise various entities,
such as leukoplakia, erythroplakia, ery- throleukoplakia, oral lichen planus,
oral submucous fibrosis (OSF) and oral dysplasia . Oral squamous cell
carcinoma (OSCC) is one of the most frequent neoplasms worldwide,
especially in countries with low- or middle-income economies, showing very
aggressive behavior, propensity for lymph-node metastasis and bad
prognosis . Overall 5-year survival rates are as low as 40%; however, if
diagnosed in the early stages (I and II), survival rates can exceed 80%. Hence,
early detection, diagnosis and treatment of premalignant lesions is mandatory
to prevent their transformation to OSCC and to increasing the 5-year survival
. rate
Different risk factors have been associated to these lesions, most of them
shared with OSCC, but the mechanisms and the causes of malignant
transformations remain unclear. Lifestyle factors, such as use of tobacco,
consumption of alcohol, derivatives of betel nut and sexually transmitted
infection of human papilloma virus (HPV, mainly type 16) represent the main
causes associated with OPMDs and oral cancer. Moreover, chronic mucosal
inflam- mation and oral mucosal trauma from teeth and prosthetic devices
have received increasing attention in several clinical and scientific studies .
Other suggested factors in common between oral cancer and premalignant
lesions are alteration of the microbiome, systemic sclerosis, genetic disease
with dysregulation of DNA metabolism (Zinsser–Engman–Cole syndrome,
Fanconi anemia and Xeroderma pigmantosum), hematinic and micronutrient
deficiency
::Definition
Oral potentially malignant disorders (OPMDs) include a group of conditions
that affect the oral mucosa with an increased risk of malignancy. During their
evolution visible changes may be found in the colour or in the thickness of the
oral mucosa and these changes can be detected during an oral examination.
Their clinical presentations are diverse and their natural history is not well
described. Oral leukoplakia is the most commonly encountered OPMD in
clinical practice. Use of optical fluorescence imaging or staining with toluidine
blue may increase the number of lesions detected compared to oral visual
examination alone and may increase border distinction at a subjective level.
When stratifying their risk consideration is given to the presence of red areas,
size exceeding 200 mm2, presence of lichenoid features and a higher grade of
dysplasia in the pathology report. Up to a third of OPMDs may transform to
.squamous cell carcinomas

Classification of Oral Potentially Malignant Disorders

As far as we know no attempt has been made to classify oral PMDs till date, a
possible classification could be
High Risk .1
.Erythroplakia .1.1
.Leukoplakia .1.2
.Oral Submucous Fibrosis (OSF). 1.4. Erosive Lichen Planus .1.3
Life-style Related .2
.Smokeless Tobacco Keratosis. 2.2. Reverse Smoker’s Palate .2.1
.Actinic Cheilitis .2.3
Infections .
.Hyperplastic Candidiasis .3.1
.Viral (HPV, HIV, EBV, HBV, HSV). 3.3. Tertiary Syphilis .3.2
Immunodeficiency .4
.Solid Organ Transplantation .4.1
.Graft Versus Host Disease .4.2
.Chronic Cutaneous Lupus Erythematous .4.3
Inherited Disorders .5
Xeroderma Pigmentosum. 5.2. Dyskeratosis Congenita. 5.3. Epidermolysis .5.1
.Bullosa. 5.4. Bloom Syndrome
.Fanconi’s Anemia .5.5

Diagnostic aids in detection of potentially malignant disorders 17,18

Development and use of diagnostic aids that would help the oral health care
professionals to readily identify persistent oral lesions of uncertain biologic

significance are essential to improve their ability to detect relevant PMDs at

their most incipient stage. A variety of commercial diagnostic aids and
adjunctive techniques are now available to assist us in the screening of
.healthy patients
Clinical Methods .1
.a. Conventional Oral Examination (COE). b. Vital Staining
.®Optical Methods a. Vizilite .2
.®b. MicroLux DL®. c. VELscope
d. Fluorescence Spectroscopy. 3. Imaging Methods
.a. Computed Tomography (CT)
.b. Magnetic Resonance Imaging (MRI)
.c. Positron Emission Tomography (PET). d. Thalium-201 (201Tl) Scintigraphy
.e. Photoactive Imaging
.f. Optical Coherence Tomography (OCT). g. Narrow Band Imaging (NBI)
.h. Nano Diagnostic Methods
.Histopathological Methods a. Scalpel Biopsy .4
.b. OralCDx Brush Test®. c. Cytology
d. Laser Capture Micro Dissection. 5. Molecular Methods
.a. Immuno Histochemistry
.b. Flow Cytometry
.c. Polymerase Chain Reaction (PCR)
.d. Blotting Techniques
.e. Spectral Karyotyping
.f. AgNOR
.g. Fluorescent In-situ Hybridization (FISH). h. DNA Microarray
.i. Comparative Genomic Hybridization
Salivary Diagnostic Methods a. Protein Electrophoresis. b. Sialochemistry .6

:References
Garcia M, Jemal A, Ward EM, Center MM, Hao Y, Siegel RL, Thun MJ (ed.’s). .1
Global Cancer Facts & Figures 2007. Atlanta, GA: American Cancer Society,
.2007
Olshan FA (ed.). Epidemiology, Pathogenesis, and Prevention of Head and .2
.Neck Cancer. London, Springer, 2010. doi: 10.1007/978-1-4419-1472-9
Neville BW, Day TA. Oral Cancer and Precancerous Lesions. CA Cancer J .3
.Clin. 2002;52:195-215. doi:10.3322/canjclin.52.4.195
Fedele S. Diagnostic aids in the screening of oral cancer. Head & Neck .4
.Oncology

Fatima e mohamed -
D-16-172