Mouth cancer for clinicians part 6: potentially malignant disorders

From Volume 42, Issue 9, November 2015 | Pages 866-877

Authors

Nicholas Kalavrezos

FRCS, FFD RCSI, MD

Consultant in Head and Neck/Reconstructive Surgery, Head and Neck Centre, University College London Hospitals, London, UK

Articles by Nicholas Kalavrezos

Crispian Scully

CBE, DSc, DChD, DMed (HC), Dhc(multi), MD, PhD, PhD (HC), FMedSci, MDS, MRCS, BSc, FDS RCS, FDS RCPS, FFD RCSI, FDS RCSEd, FRCPath, FHEA

Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK

Articles by Crispian Scully

Abstract

A MEDLINE search early in 2015 revealed more than 250,000 papers on head and neck cancer; over 100,000 on oral cancer; and over 60,000 on mouth cancer. Not all publications contain robust evidence. We endeavour to encapsulate the most important of the latest information and advances now employed in practice, in a form comprehensible to healthcare workers, patients and their carers. This series offers the primary care dental team, in particular, an overview of the aetiopathogenesis, prevention, diagnosis and multidisciplinary care of mouth cancer, the functional and psychosocial implications, and minimization of the impact on the quality of life of patient and family.

Clinical Relevance: This article offers the dental team an overview of oral potentially malignant disorders.

Article

Some mouth cancers are preceded by clinically obvious potentially malignant disorders (PMDs); most are probably not and arise in clinically apparently normal mucosa. Nevertheless, molecular changes must precede histopathological and clinically detectable lesions. Risk factors for the PMD are generally those as for OSCC (Articles 3, 4, 5).

Some mouth cancers are preceded by clinically obvious potentially malignant disorders (PMDs). There is a range of PMDs known but the most important recognized are erythroplakia (erythroplasia), leukoplakia, lichenoid lesions, actinic cheilitis and submucous fibrosis (Table 1 and Figures 19; see also Article 7) and many cancers are associated with such lesions (especially in South-East Asian people).

Of course PMDs, although regarded as early lesions in possible progression to malignancy, may well, in molecular terms, be rather ‘late’ (Article 1) in that several genetic changes may be present with no clinical signs detectable.

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