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Yang SW, Lee YC, Lee YS, Chang LC, Lai YR. Risk assessment of malignant transformation of oral leukoplakia in patients with previous oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2022; 51:1394-1400. [DOI: 10.1016/j.ijom.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 10/18/2022]
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CAMPOS WGD, ESTEVES CV, GALLO CDB, DOMANESCHI C, ARANHA ACC, LEMOS CA. Treatment of oral leukoplakia with CO2 laser (10,600 nm): analysis of 37 cases. Braz Oral Res 2022; 36:e014. [DOI: 10.1590/1807-3107bor-2022.vol36.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/01/2021] [Indexed: 11/22/2022] Open
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Yao Y, Shi L, Wang Y, Shen X, Ye S, Tang G, Wu L. Ablative fractional laser-assisted photodynamic therapy vs. ablative fractional laser for oral leukoplakia treatment: A randomized, controlled pilot study. Photodiagnosis Photodyn Ther 2021; 36:102523. [PMID: 34487871 DOI: 10.1016/j.pdpdt.2021.102523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Ablative fractional laser-assisted photodynamic therapy (AFL-PDT) is explored as an effective method in some premalignant diseases, whereas the effect of AFL-PDT on oral leukoplakia (OL), the best-known precursor of oral squamous cell carcinoma, remains undetermined. METHODS Forty-eight patients, histologically diagnosed with OL, were randomized (1:1) to receive either AFL-PDT or ablative fractional laser (AFL) treatment. All patients were followed up at 1, 3, 6 and 12 months postoperatively. The primary endpoints of efficacy and clinical recurrence and the secondary endpoint of side effects were assessed. RESULTS Forty-four patients completed the study. The 100% effective cure rate in the AFL-PDT group was higher than that in AFL group (80.9%, P<0.05) with 19.1% difference (95%CI: 0.7-40.0%). Compared to AFL group, recurrence observed at 6 and 12 months post-treatment tended to occur in fewer patients in the AFL-PDT group (P<0.05). No severe adverse events or systemic side effects were observed in either group. CONCLUSIONS AFL-PDT may effectively reduce recurrence of OL with high clinical efficacy and good tolerability, suggesting it may be a promising treatment for OL.
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Affiliation(s)
- Yilin Yao
- Department of Oral Mucosal disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; National Clinical Research Center for Oral Diseases, Shanghai 200011, China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
| | - Linjun Shi
- Department of Oral Mucosal disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; National Clinical Research Center for Oral Diseases, Shanghai 200011, China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
| | - Yufeng Wang
- Department of Oral Mucosal disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; National Clinical Research Center for Oral Diseases, Shanghai 200011, China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
| | - Xuemin Shen
- Department of Oral Mucosal disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai 200011, China; National Center for Stomatology, Shanghai 200011, China
| | - Sai Ye
- Department of Oral Mucosal disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; National Clinical Research Center for Oral Diseases, Shanghai 200011, China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
| | - Guoyao Tang
- Department of Oral Mucosal disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai 200011, China; National Center for Stomatology, Shanghai 200011, China; National Clinical Research Center for Oral Diseases, Shanghai 200011, China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China..
| | - Lan Wu
- Department of Oral Mucosal disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; National Clinical Research Center for Oral Diseases, Shanghai 200011, China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China..
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Yang SW, Lee YS, Wu PW, Chang LC, Hwang CC. A Retrospective Cohort Study of Oral Leukoplakia in Female Patients-Analysis of Risk Factors Related to Treatment Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168319. [PMID: 34444068 PMCID: PMC8393383 DOI: 10.3390/ijerph18168319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 12/20/2022]
Abstract
Background: The aim of this study was to make a comparison of clinicopathological characteristics of oral leukoplakia between male and female patients following carbon dioxide laser excision for oral leukoplakia and analyze the factors associated with the treatment outcomes in female patients. Methods: Medical records of patients with oral leukoplakia receiving laser surgery from 2002 to 2020 were retrospectively reviewed and analyzed statistically. Results: A total of 485 patients were enrolled, including 412 male (84.95%) and 73 female (15.05%). Regarding the locations, the predilection site of oral leukoplakia in male patients was buccal mucosa (p = 0.0001) and that for women patients was tongue (p = 0.033). The differences of recurrence and malignant transformation between both sexes were not significant (p > 0.05). Among female patients, area of oral leukoplakia was the risk factor related to recurrence (p < 0.05). Clinical morphology and postoperative recurrence were the risk factors related to malignant transformation (p < 0.05). Conclusions: In comparison with male patients, there was no significant difference of the postoperative recurrence and malignant transformation of oral leukoplakia in female patients. Among the female patients, clinicians should pay more attention to large-sized and non-homogeneous leukoplakia, and postoperative recurrent lesions.
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Affiliation(s)
- Shih-Wei Yang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung 204, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (L.-C.C.); (C.-C.H.)
- Department of Otolaryngology-Head and Neck Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
- Correspondence: ; Tel.: +886-2-24313131 (ext. 6317)
| | - Yun-Shien Lee
- Department of Biotechnology, Ming Chuan University, Taoyuan 333, Taiwan;
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Pei-Wen Wu
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung 204, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (L.-C.C.); (C.-C.H.)
| | - Liang-Che Chang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (L.-C.C.); (C.-C.H.)
- Department of Pathology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Cheng-Cheng Hwang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (L.-C.C.); (C.-C.H.)
- Department of Pathology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
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Erira AT, Navarro AFR, Robayo DAG. Human papillomavirus, Epstein-Barr virus, and Candida albicans co-infection in oral leukoplakia with different degrees of dysplasia. Clin Exp Dent Res 2021; 7:914-923. [PMID: 34101999 PMCID: PMC8543472 DOI: 10.1002/cre2.435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To identify human papillomavirus (HPV), Epstein-Barr virus (EBV), and Candida albicans in oral leukoplakia with different degrees of dysplasia. MATERIALS AND METHODS An observational, cross-sectional, descriptive study was performed using 30 formalin-fixed and paraffin-embedded tissues from patients with clinical suspicion of leukoplakia and confirmed diagnosis of oral dysplasia. Histological analyses were performed by two pathologists (interobserver) and dysplasias were classified as mild, moderate, or severe. Conventional PCR was used to detect HPV and EBV viruses and C. albicans. To determine the association between each microorganism with different degrees of dysplasia a Chi-square test was employed. RESULTS The tongue was the most common site for leukoplakias (71.4%) in females with a mean age of 50 years (ranging between 30 to 50 years old; 57.1%). EBV was the most frequently detected (73.3%), followed by HPV (43.3%), mainly of type 16 (40%), and C. albicans (23.3%). Significant differences were observed between degrees of dysplasia and HPV presence (p = 0.005). In lesions positive for HPV, EBV, and C. albicans the most frequent histological changes were hyperkeratosis, irregular interpapillary ridges, and loss of basal stratum cell polarity. CONCLUSION Co-infection with human papillomavirus, Epstein Barr virus, and Candida albicans in oral leukoplakia could be associated with dysplastic changes.
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Affiliation(s)
- Alveiro T Erira
- Facultad de Odontología, Universidad Cooperativa de Colombia, Bogotá, Colombia
| | | | - Dabeiba Adriana García Robayo
- Centro de Investigaciones Odontológicas - Facultad de Odontología, Pontificia Universidad Javeriana, Bogotá, Colombia
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Yang SW, Lee YS, Chang LC, Yang CH, Luo CM, Wu PW. Oral tongue leukoplakia: analysis of clinicopathological characteristics, treatment outcomes, and factors related to recurrence and malignant transformation. Clin Oral Investig 2021; 25:4045-4058. [PMID: 33411001 PMCID: PMC8137631 DOI: 10.1007/s00784-020-03735-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The tongue is identified as a high-risk site for oral leukoplakia and malignant transformation. The purpose of this study is to investigate the clinicopathological characteristics and treatment outcomes of tongue leukoplakia and assess the factors related to recurrence and malignant transformation. MATERIALS AND METHODS One hundred and forty-four patients who received carbon dioxide laser surgery for tongue leukoplakia from 2002 to 2019 were analyzed statistically. RESULTS The follow-up period was 54.90 ± 54.41 months. Thirty patients showed postoperative recurrence (20.83%), and 12 patients developed malignant transformation (8.33%). The annual transformation rate was 2.28%. Univariate analysis showed that a history of head and neck cancer, size of lesion area, clinical appearance, and pathology were significant factors for both recurrence and malignant transformation. In the multivariate logistic regression, a history of head and neck cancer and size of lesion area were independent prognostic factors for recurrence, and a history of head and neck cancer was the only independent factor for postoperative malignant change. CONCLUSIONS Clinicians should adopt more aggressive strategies for tongue leukoplakia patients with a history of head and neck cancer. CLINICAL RELEVANCE These results may help clinicians gain a better understanding of oral tongue leukoplakia.
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Affiliation(s)
- Shih-Wei Yang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, No. 222, Mai Chin Road, Keelung, 204, Taiwan, Republic of China.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
| | - Yun-Shien Lee
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China
- Department of Biotechnology, Ming Chuan University, Taoyuan, Taiwan, Republic of China
| | - Liang-Che Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
- Department of Pathology, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Cheng-Han Yang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
- Department of Pathology, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Cheng-Ming Luo
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, No. 222, Mai Chin Road, Keelung, 204, Taiwan, Republic of China
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Pei-Wen Wu
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, No. 222, Mai Chin Road, Keelung, 204, Taiwan, Republic of China
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
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Pedroso CM, Schemberger GK, Dziadzio JL, Condolo LC, de Camargo Smolarek P. Small Dysplastic Oral Leucoplakia in a Smoking Woman: a Case Report. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2021; 12:e5. [PMID: 33959240 PMCID: PMC8085679 DOI: 10.5037/jomr.2021.12105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/25/2021] [Indexed: 11/16/2022]
Abstract
Background Oral leucoplakia is clinical term used to describe white plaques, and that is part of the group of oral potentially malignant disorders. Leucoplakia may show epithelial dysplasia, mainly in harder smoking patient. This case report discusses a small leucoplakia with dysplasia on the tongue's lateral border in a woman, diagnosed early after a routine clinical consultation. Methods A 57-year-old female patient consulted to the Oral Diagnosis and Surgery Service of the State University of Ponta Grossa, Brazil. First, the patient was referred for the extraction of her lower incisors due to periodontal disease. During clinical examination, was identified a sessile white plaque, of small size, and located on the tongue's left lateral border. Thus, the lesion's diagnostic hypothesis was oral leucoplakia due to patient be chronic smoker for 40 years. The incisional biopsy was performed, with the epithelial tissue and part of the connective tissue removed. Results The histopathological examination revealed a stratified and keratinized pavement epithelium, with cellular atypia, and presence of hyperchromatism and nuclear pleomorphism. However, the alterations were restricted to the epithelium's basal, characterizing a mild dysplasia. The proposed treatment was surgical removal of the lesion, and the patient was also instructed to quit smoking, as well as she continues to follow-up. Conclusions The presented case emphasizes the importance of early diagnosis and the orientation of risk factors to smoking patients, even in small lesions that can clinically appear harmless.
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Affiliation(s)
- Caique Mariano Pedroso
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Sao PauloBrazil
| | | | - João Lucas Dziadzio
- Department of Dentistry, State University of Ponta Grossa, Ponta GrossaBrazil
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Saldivia-Siracusa C, González-Arriagada WA. Difficulties in the Prognostic Study of Oral Leukoplakia: Standardisation Proposal of Follow-Up Parameters. FRONTIERS IN ORAL HEALTH 2021; 2:614045. [PMID: 35047990 PMCID: PMC8757698 DOI: 10.3389/froh.2021.614045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
Oral leukoplakia is the most prevalent potentially malignant disorder of the oral cavity. To evaluate its potential for malignancy, appropriate documentation of the biological parameters is crucial, allowing the patients' progression to be assessed. We hypothesized a lack of standardization in the parameters employed for the prognostic study of oral leukoplakia; our aims were to determine the different parameters used for follow-up according to definition, importance, and frequency of use, and to provide a standardization proposal of follow-up research. We made a scoping review to identify papers with the keywords “leukoplakia,” “oral,” and “follow-up” published until June 2019 in English, Spanish and Portuguese literature through an online search in PUBMED, SCIELO, and SCOPUS databases. In total, 514 articles were initially identified, and fifty-nine publications were selected, of which 37 were retrospective. The reports included a total of 18,660 patients between 13 and 98 years old, with a mean age of 57.6 years. Tobacco and alcohol habits were positive for 77 and 37% of the patients, respectively. Our results showed that reported leukoplakias were predominantly located on buccal mucosa (40.4%), were homogeneous (60.8%), multiple (59.9%), smaller than 2 cm (74.4%) and histopathologically non-dysplastic (71%). The mean follow-up time was 55 months, with a 13% malignant transformation rate. The categorization and definition of multiple variables were notably diverse. Age, sex, habits (tobacco and alcohol), site, size, distribution, morphology, degree of dysplasia, and evolution were the chosen parameters for our proposal. The current study reflected the lack of consensus found in the literature regarding parameters for diagnosis or follow-up, impacting negatively on clinical and research results. standardization comprises an efficient way to facilitate the prognosis assessment of oral leukoplakia, being beneficial for clinical practice, and enabling better quality information to apply in research.
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Affiliation(s)
| | - Wilfredo Alejandro González-Arriagada
- Patología y Diagnóstico Oral, Facultad de Odontología, Universidad de Valparaíso, Valparaíso, Chile
- Centro de Investigación Interoperativo en Ciencias Odontológicas y Médicas (CIICOM), Universidad de Valparaíso, Valparaíso, Chile
- *Correspondence: Wilfredo Alejandro González-Arriagada
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An anatomical perspective on clinicopathological characteristics and treatment outcomes of dorsal and ventrolateral tongue leukoplakia after carbon dioxide laser surgery. BMC Oral Health 2021; 21:45. [PMID: 33509189 PMCID: PMC7844937 DOI: 10.1186/s12903-021-01403-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/08/2021] [Indexed: 12/18/2022] Open
Abstract
Background The tongue has been identified as a high-risk site for malignant transformation of oral leukoplakia. The purpose of this study was to investigate the clinicopathological characteristics and treatment outcomes of the dorsal and ventrolateral tongue leukoplakia. Methods Demographic data and pathological results of patients who underwent carbon dioxide laser surgery for tongue leukoplakia from 2002 to 2019 were retrospectively reviewed and analyzed statistically. Results Of the 111 patients enrolled, 80 were males and 31 females, with a mean age of 51.86 ± 11.84 years. The follow-up time was 3.74 ± 4.19 years. Fifteen patients had a postoperative recurrence (13.51%). Four (3.6%) patients developed malignant transformation. Annual transformation rate was 4.03%. There were no differences in the time to develop carcinoma (3.19 ± 1.94 vs. 3.51 ± 2.12 years, P = 0.83), overall cumulative malignant transformation rates (7.41% vs. 2.25%, P = 0.12), and annual transformation rates (2.32% vs. 0.64%, P = 0.099). The prevalence of the ventrolateral tongue leukoplakia was higher than that of the dorsal tongue leukoplakia (P < 0.001). The results of multivariate logistic regression analysis showed that the degree of pathology was the only independent prognostic factor related to postoperative malignant transformation (P = 0.045). Conclusions Dorsal tongue leukoplakia is not as frequently encountered clinically as ventrolateral tongue leukoplakia. The response of the dorsal tongue and ventrolateral tongue leukoplakia to laser therapy of are comparable in postoperative recurrence and postoperative malignant transformation. Clinicians should take a more aggressive attitude toward oral tongue leukoplakia with higher grade of dysplasia.
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de Pauli Paglioni M, Migliorati CA, Schausltz Pereira Faustino I, Linhares Almeida Mariz BA, Oliveira Corrêa Roza AL, Agustin Vargas P, Franco Paes Leme A, Bianca Brandão T, Prado Ribeiro AC, Ajudarte Lopes M, Santos-Silva AR. Laser excision of oral leukoplakia: Does it affect recurrence and malignant transformation? A systematic review and meta-analysis. Oral Oncol 2020; 109:104850. [PMID: 32540612 DOI: 10.1016/j.oraloncology.2020.104850] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022]
Abstract
Oral leukoplakia (OL) is a white lesion with high potential of recurrence and malignant transformation. The variable clinical and histopathological features of OL may potentially impact both treatment and prognosis. Current literature shows that post treatment rates of recurrence and malignant transformation vary widely. The use of surgical lasers have been proposed with the objective of improving outcomes. We performed a systematic review and a comprehensive meta-analysis dedicated to pooling the rates of recurrence and malignant transformation of OL lesions treated using the main types of surgical lasers available. Scopus, MEDLINE/PubMed, and Embase were searched electronically. A total of 36 articles met the inclusion criteria. Selected studies included OL lesions that were treated by evaporation or excision using Nd:YAG laser, Er:YAG laser, CO2 laser, KTP laser, or diode laser. The results of this systematic review and meta-analysis suggest that surgical laser excision of OL may decrease recurrence rates but have no effect on the malignant transformation of OL when compared with conventional treatments.
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Affiliation(s)
- Mariana de Pauli Paglioni
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
| | | | | | | | | | - Pablo Agustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | | | | | | | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
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Iocca O, Sollecito TP, Alawi F, Weinstein GS, Newman JG, De Virgilio A, Di Maio P, Spriano G, Pardiñas López S, Shanti RM. Potentially malignant disorders of the oral cavity and oral dysplasia: A systematic review and meta-analysis of malignant transformation rate by subtype. Head Neck 2019; 42:539-555. [PMID: 31803979 DOI: 10.1002/hed.26006] [Citation(s) in RCA: 213] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Potentially malignant disorders of the oral cavity (OPMD) are a heterogeneous group of lesions associated with a variable risk of malignant transformation (MT) to invasive cancer. Leukoplakia (LE), lichen planus (LP), oral lichenoid lesions (OLL), oral erythroplakia (OE), oral submucous fibrosis (OSF), and proliferative verrucous leukoplakia (PVL) are among the most common of these lesions. Oral dysplasia is a mucosal area characterized by cellular and architectural derangement, which may be associated with OPMDs or not. OBJECTIVE To define the MT rate of OPMDs and the risk of development into cancer of mild vs moderate/severe oral dysplasia. This in order to implement adequate follow-up strategies and treatment decisions. STUDY DESIGN We performed a systematic review and meta-analysis on studies reporting the MT rates of OPMDs and oral dysplasia. Ninety-two studies were included for the analysis. Cumulative rates were reported for OPMDs overall and as a subgroup, a comparison was made of mild vs moderate/severe dysplasia. Meta-regression on OPMD and year of publication was also performed. MAIN OUTCOME AND MEASURES Overall MT rates of OPMDs and odds ratio of MT of mild vs moderate/severe dysplasia. RESULTS Overall MT rate across all OPMD groups was 7.9% (99% confidence interval [CI] 4.9%-11.5%). MT rates of the specific OPMD subgroups were as follows: LP 1.4% (99% CI 0.9%-1.9%), LE 9.5 (5.9%-14.00%), OLL 3.8% (99% CI 1.6%-7.00%), OSF 5.2% (99% CI 2.9%-8.00%), OE 33.1% (99% CI 13.6%-56.1%), and PVL 49.5% (99% CI 26.7%-72.4%). Regarding the dysplasia grades comparison, the meta-analysis showed that moderate/severe dysplasia is meaningfully associated to a much greater risk of MT compared to mild dysplasia with an odds ratio of 2.4 (95% CI 1.5-3.8) [Correction added on 27 December 2019, after first online publication: CI updated from 99% to 95%.]. Heterogeneity was not significant. Annual MT rates were approximated based on the average follow-up as reported in the various subgroups. Lichen planus had an annual MT of 0.28%, OLL of 0.57%, leukoplakia of 1.56%, PVL of 9.3%, and OSF of 0.98%. Mild dysplasia had an annual MT of 1.7%, while severe dysplasia of 3.57%. Meta-regression showed a significant negative correlation of PVL MT rate and year of the study (P value <.001). CONCLUSIONS AND RELEVANCE OPMDs and oral dysplasia are relatively common conditions that general practitioners, head and neck, and oral medicine specialists, face in their everyday practice. Our analysis confirms the significant risk of MT of these lesions, although variable among the subgroups. Moderate/severe dysplasia bears a much higher risk of cancer evolution than mild dysplasia. It is important to raise public health awareness on the MT rates of these conditions, at the same time efficacious communication with the patient is of utmost importance. This, coupled with strict follow-up measures and optimal treatment strategies, would help in reducing the transformation of these oral conditions into invasive cancer.
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Affiliation(s)
- Oreste Iocca
- Department of Otorhinolaryngology-Head and Neck Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Thomas P Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Faizan Alawi
- Department of Pathology, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Gregory S Weinstein
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jason G Newman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Armando De Virgilio
- Department of Otorhinolaryngology-Head and Neck Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Pasquale Di Maio
- Giovanni Borea Civil Hospital, Department of Otolaryngology-Head and Neck Surgery, Sanremo, Italy
| | - Giuseppe Spriano
- Department of Otorhinolaryngology-Head and Neck Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Simón Pardiñas López
- Periodontology and Oral Surgery, Clínica Médico Dental Pardiñas, Cell Therapy and Regenerative Medicine Group, Centre for Advanced Scientific Research (CICA) and Biomedical Research Institute of A Coruña (INIBIC) Strategic Group, Universidade da Coruña (UDC), University Hospital Complex of A Coruña (CHUAC), Galician Health Service (SERGAS), A Coruña, Spain
| | - Rabie M Shanti
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine, Philadelphia, PA
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Saibene AM, Rosso C, Castellarin P, Vultaggio F, Pipolo C, Maccari A, Ferrari D, Abati S, Felisati G. Managing Benign and Malignant Oral Lesions with Carbon Dioxide Laser: Indications, Techniques, and Outcomes for Outpatient Surgery. Surg J (N Y) 2019; 5:e69-e75. [PMID: 31392277 PMCID: PMC6682487 DOI: 10.1055/s-0039-1694735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 07/02/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose
Because of its affinity for water-based tissues, carbon dioxide (CO
2
) laser has become an instrument of choice for treating oral mucosa conditions, ranging from inflammatory to malignant lesions. The aim of this work is to systematically evaluate the outcomes of laser surgery over a wide range of lesions, while providing a solid and reproducible protocol for CO
2
laser surgery in the outpatient management of oral lesion.
Methods
Seventy-eight patients underwent 92 laser outpatient procedures for treatment of a wide range of benign and malignant lesions. We performed 60 removals, 11 exeretic biopsies, 15 vaporizations, and 3 vaporization/removal combined. We analyzed laser parameters applied for each technique and provided a systematic evaluation of surgical results.
Results
No problems occurred intraoperatively in any of the patients. Five patients complained marginal pain, while 3 patients had postsurgery bleeding. All treatments were successful, with the notable exception of 3 relapsing verrucous proliferative leukoplakias and an infiltrating squamous cell carcinoma of the tongue requiring radicalization. We did not record any adverse reactions to drugs or lesions due to laser action. Concordance between clinical diagnosis and pathology results was at 94.8%.
Conclusions
Our data indicate that CO
2
laser is a solid choice for outpatient treatment of oral lesions. This technique grants painless and almost bloodless treatment, with negligible recurrence rates. Providing a solid reference for laser settings and operative techniques could provide a foundation for further exploring this tool while offering the basis for a positive comparison between different surgical techniques and options.
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Affiliation(s)
| | - Cecilia Rosso
- Department of Otolaryngology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Paolo Castellarin
- Department of Biomedical, Surgical and Dental Sciences, Odontostomatology Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Federica Vultaggio
- Department of Otolaryngology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Carlotta Pipolo
- Department of Otolaryngology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Alberto Maccari
- Department of Otolaryngology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Daris Ferrari
- Department of Oncology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Silvio Abati
- Department of Dentistry, Unit of Oral Pathology, IRCCS San Raffaele University Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Felisati
- Department of Otolaryngology, San Paolo Hospital, University of Milan, Milan, Italy
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13
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The Effectiveness of Laser-Assisted Surgical Excision of Leukoplakias and Hyperkeratosis of Oral Mucosa: A Case Series in A Group of Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020210. [PMID: 30642122 PMCID: PMC6352160 DOI: 10.3390/ijerph16020210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 12/26/2018] [Accepted: 01/09/2019] [Indexed: 01/19/2023]
Abstract
Introduction: In the different branches of dentistry, the use of laser to solve different clinical situations is increasing due to numerous advantages that have been studied in literature since the 70s. Leucoplakia and hyperkeratosis can benefit from laser-assisted treatment. In most cases biopsy sampling, histological examination and, if no malignant cells are present, the follow-up is needed. However, even if the lesion is free of dysplasia patients often ask to eliminate these white spots that are always a cause of concern. Aim: From these numerous requests comes the idea of setting up a laser-assisted protocol as less invasive as possible to be offered to patients. The aim of the study is to find a laser-assisted protocol for the surgical excision of leucoplakia and hyperkeratosis that can both improve the clinical aspect of the lesion and be sustainable for patients. The null hypothesis has been identified in the following statement: the treatment is effective and efficient at the same time; where effectiveness was tested with the following criteria: size of the lesion, tactile perception, discomfort, pain; and efficiency with the following criteria: pain and discomfort perceived during the treatment. Materials and methods: To collect all data, a specially designed medical record was used. The diode laser was used with a pulsed mode and the maximum power corresponds to 1.8 W. No anaesthesia was used. Before laser-assisted treatment, the fibre was activated and was used with a contact overflowing. Results: Our results show a decrease in the size of the lesion statistically significant. No pain was referred during treatment, except for a slight burning sensation. Conclusion: In conclusion we can state that the treatment is both efficient and effective.
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Strome A, Kossatz S, Zanoni DK, Rajadhyaksha M, Patel S, Reiner T. Current Practice and Emerging Molecular Imaging Technologies in Oral Cancer Screening. Mol Imaging 2018; 17:1536012118808644. [PMID: 32852263 PMCID: PMC6287312 DOI: 10.1177/1536012118808644] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Oral cancer is one of the most common cancers globally. Survival rates for patients are directly correlated with stage of diagnosis; despite this knowledge, 60% of individuals are presenting with late-stage disease. Currently, the initial evaluation of a questionable lesion is performed by a conventional visual examination with white light. If a lesion is deemed suspicious, a biopsy is taken for diagnosis. However, not all lesions present suspicious under visual white light examination, and there is limited specificity in differentiating between benign and malignant transformations. Several vital dyes, light-based detection systems, and cytology evaluation methods have been formulated to aid in the visualization process, but their lack of specific biomarkers resulted in high false-positive rates and thus limits their reliability as screening and guidance tools. In this review, we will analyze the current methodologies and demonstrate the need for specific intraoral imaging agents to aid in screening and diagnosis to identify patients earlier. Several novel molecular imaging agents will be presented as, by result of their molecular targeting, they aim to have high specificity for tumor pathways and can support in identifying dysplastic/cancerous lesions and guiding visualization of biopsy sites. Imaging agents that are easy to use, inexpensive, noninvasive, and specific can be utilized to increase the number of patients who are screened and monitored in a variety of different environments, with the ultimate goal of increasing early detection.
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Affiliation(s)
- Arianna Strome
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susanne Kossatz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Milind Rajadhyaksha
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Snehal Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiology, Weill-Cornell Medical College, New York, NY, USA
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15
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Malignant transformation of oral leukoplakia treated with carbon dioxide laser: a meta-analysis. Lasers Med Sci 2018; 34:209-221. [DOI: 10.1007/s10103-018-2674-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/25/2018] [Indexed: 01/11/2023]
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16
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Antunes JLF, Domaneschi C, Lemos CA. Noninferiority trials in oral medicine. Oral Dis 2018; 25:357-362. [PMID: 29766614 DOI: 10.1111/odi.12892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
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17
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Cloitre A, Rosa RW, Arrive E, Fricain JC. Outcome of CO2 laser vaporization for oral potentially malignant disorders treatment. Med Oral Patol Oral Cir Bucal 2018; 23:e237-e247. [PMID: 29476671 PMCID: PMC5911355 DOI: 10.4317/medoral.21984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 12/04/2017] [Indexed: 11/23/2022] Open
Abstract
Background Oral cancer is a public health issue worldwide. Oral potentially malignant disorders (OMPDs) are lesions of the oral mucosa that are predisposed to malignant transformation. The mainstay of OMPDs treatment around the world is now the carbon dioxide (CO2) laser but the reported recurrence and malignant transformation rates vary widely in the literature. We aimed to estimate the recurrence and the malignant transformation rates of OPMDs treated with CO2 laser at the University Hospital of Bordeaux, in France, from 2010 to 2014, and to identify associated factors with recurrence or malignant transformation. Material and Methods We conducted a retrospective study in patients with a minimum follow-up of 12 months. Collected variables included characteristics of the patients (gender, age, alcohol and tobacco consumption, previous diagnosis of graft-versus-host disease, previous treatments for OPMD or for upper aerodigestive tract cancers and human immunodeficiency virus infection), characteristics of the lesions (form, colour, size, location, degree of dysplasia), laser treatment outcome (complications, recurrence, malignant transformation). Results Twenty-five patients were included. Mean follow-up was 28.9 months. Recurrence was observed in 11 patients (44%). Annual recurrence rate was 18.3% and annual malignant transformation rate was 1.7%. Hyperplasia without dysplasia was the only factor found to be statistically associated with recurrence. Conclusions Our results suggest that OMPDs treated by CO2 laser vaporization have high recurrence rates, particularly those presenting hyperplasia. A standardized definition of recurrence would be necessary for inter-study comparisons. Long-term follow-up is recommended in order to detect and treat squamous cell carcinoma in its early stages. Key words:CO2 lasers, precancerous conditions, malignant transformation, oral cancer, recurrence.
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Affiliation(s)
- A Cloitre
- Université de Nantes UFR d'Odontologie, 1 Place Alexis Ricordeau, 44042 Nantes Cedex 1, France,
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18
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Monteiro L, Barbieri C, Warnakulasuriya S, Martins M, Salazar F, Pacheco JJ, Vescovi P, Meleti M. Type of surgical treatment and recurrence of oral leukoplakia: A retrospective clinical study. Med Oral Patol Oral Cir Bucal 2017; 22:e520-e526. [PMID: 28809365 PMCID: PMC5694172 DOI: 10.4317/medoral.21645] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/19/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Oral leukoplakia (OL) is the most typical potentially malignant disorder of the oral mucosa. We aimed to evaluate the clinical outcome of oral leukoplakia treated with several types of lasers and with the use of quantic molecular resonance (QMR) lancet, in terms of recurrence rate. MATERIAL AND METHODS Eighty-seven previously untreated OL (52 occurring in females and 35 in males, mean age of 59.4 ± 13.9 years) were consecutively submitted to surgical treatment at University Hospital of Parma, Italy, and Hospital de Valongo, Portugal, (1999 to 2012). Interventions were subclassified into 5 groups according to the instrument used for the surgical removal of OL (cold blade - 17; Nd:YAG 1064nm laser - 14; Er:YAG 2940nm laser - 33; CO2 10600nm laser - 15; and QMR scalpel - 8). The mean follow-up period after treatment was 21.6 months (range 1-151 months). The outcome of treatment was scored through the same clinical protocol in the two participating units. Statistical analysis were carried by univariate analysis using chi-square test (or Pearson's test when appropriate). RESULTS Recurrences were observed in 24 cases of OL (27.6%). Malignant transformation occurred in one patient (1.1%) after a period of 35 months. Statistical comparison of the 5 surgical treatment modalities showed no differences in clinical outcomes nor in the recurrence rate of OL. However, when Er:YAG laser group was compared with traditional scalpel, a significantly better outcome in cases treated with Er:YAG laser (P = 0.015) was highlighted. CONCLUSIONS Our results suggests that Er:YAG laser could be a promising option for the treatment of OL.
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Affiliation(s)
- L Monteiro
- Medicine and Oral Surgery Department, Instituto Univesitário de Ciências da Saúde, Rua Central de Gandra, 1317, 4585-116 Gandra PRD, Portugal,
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19
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Thomson P, Goodson M, Cocks K, Turner J. Interventional laser surgery for oral potentially malignant disorders: a longitudinal patient cohort study. Int J Oral Maxillofac Surg 2017; 46:337-342. [DOI: 10.1016/j.ijom.2016.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 09/07/2016] [Accepted: 11/02/2016] [Indexed: 02/03/2023]
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20
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Camisasca DR, da Rós Gonçalves L, Soares MR, Sandim V, Nogueira FCS, Garcia CHS, Santana R, de Oliveira SP, Buexm LA, de Faria PAS, Dias FL, Pereira DDA, Zingali RB, Alves G, Lourenço SQC. A proteomic approach to compare saliva from individuals with and without oral leukoplakia. J Proteomics 2016; 151:43-52. [PMID: 27478070 DOI: 10.1016/j.jprot.2016.07.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Oral leukoplakia is the most common potentially malignant disorder in the oral cavity and can precede carcinoma. This study aimed to identify possible oral leukoplakia salivary biomarkers. METHODS Unstimulated saliva was collected from participants and protein concentration was determined. Proteins were then precipitated with cold acetone and separated using 2DE over a pH range of 3-10. Spot demarcation and matching were performed and protein identification was done through MS analysis. Oral leukoplakia tissues were submitted to immunohistochemistry analysis for keratin 10 (CK10). A complementary analysis of oral leukoplakias that were not included previously was performed in addition. RESULTS 226±10 spots were identified in oral leukoplakia 2DE gels, and 262±12 spots were identified in volunteers. Twenty-two spots were highly abundant in oral leukoplakias or not detected in the control group, such as apolipoprotein A1, alpha amylase, cystatins, keratin 10, and lysozyme precursor. All were identified. All oral leukoplakia cases were immunopositive for CK10, mainly in the superficial epithelial layers. CONCLUSIONS The 2DE salivary protein profiles of individuals with and without oral leukoplakia were observably different. CK10 appears to be an interesting protein and should be further studied in oral carcinogenesis. SIGNIFICANCE MS-based proteomics enables large-scale analysis of proteins. Proteomics can provide detailed descriptions of proteomes of cells and tissues, including body fluids, and appears as a powerful tool to study human disorders. Saliva is readily accessible through non invasive collection and can mirror diverse disease states. Saliva from both diseased and healthy subjects can be analyzed through 2DE and differences between groups could be found. Routine immunohistochemistry analysis confirmed one of these findings, with CK10 being positive tissues from individuals with oral leukoplakia. Therefore, the present study allows insights into development of an important potential oral cancer precursor, named oral leukoplakia. However, the results can be extrapolated and tested in other precancer states, such as proliferative verrucous leukoplakia, patients at risk of oral cancer due to lifestyle behavior and/or cancer history in the family or even those who are under surveillance after a treated primary oral cancer.
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Affiliation(s)
- Danielle Resende Camisasca
- Oral Pathology, Federal Fluminense University (UFF), R. Marques de Paraná, 303/4° andar (Hospital Universitário Antônio Pedro), Centro Niterói, Brazil, CEP: 24033-900.
| | - Lorena da Rós Gonçalves
- Serviço de Hematologia, Laboratório de Genética Aplicada, Brazilian National Cancer Institute (INCA), Hospital do Câncer I, Praça da Cruz Vermelha, 23 - 6° andar, Rio de Janeiro, RJ, Brazil, CEP: 20230-130.
| | - Márcia Regina Soares
- Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Av. Athos daSilveira, 149/541, Cidade Universitária, Rio deJaneiro, RJ, Brazil, CEP: 21941-909.
| | - Vanessa Sandim
- Serviço de Hematologia, Laboratório de Genética Aplicada, Brazilian National Cancer Institute (INCA), Hospital do Câncer I, Praça da Cruz Vermelha, 23 - 6° andar, Rio de Janeiro, RJ, Brazil, CEP: 20230-130; Laboratório de Hemostase e Venenos e Unidade de Espectrometria de Massas e Proteômica, Instituto de Bioquímica Médica, Programa de Biologia Estrutural, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, CCS Bloco H2 sala 04, Cidade Universitária, Rio de Janeiro, RJ, Brazil, CEP 21941-902.
| | - Fábio César Sousa Nogueira
- Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Av. Athos daSilveira, 149/541, Cidade Universitária, Rio deJaneiro, RJ, Brazil, CEP: 21941-909.
| | - Carlos Henrique Saraiva Garcia
- Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Av. Athos daSilveira, 149/541, Cidade Universitária, Rio deJaneiro, RJ, Brazil, CEP: 21941-909.
| | - Rodrigo Santana
- Serviço de Hematologia, Laboratório de Genética Aplicada, Brazilian National Cancer Institute (INCA), Hospital do Câncer I, Praça da Cruz Vermelha, 23 - 6° andar, Rio de Janeiro, RJ, Brazil, CEP: 20230-130.
| | - Silvia Paula de Oliveira
- Odontoclínica Central do Exército (OCEX), Praça da República, 123 - Centro, Rio de Janeiro, RJ, Brazil, CEP: 20211-340.
| | - Luisa Aguirre Buexm
- Oncology Graduate Program, Molecular Carcinogenesis Program, Research Center, Brazilian National Cancer Institute, Rua André Cavalcanti, 37, 6° andar, Centro, 20231-050 Rio de Janeiro, RJ, Brazil.
| | - Paulo Antônio Silvestre de Faria
- Pathology Division (Divisão de Patologia), Brazilian National Cancer Institute (INCA), Rua Cordeiro da Graça, 156, Rio de Janeiro, RJ, Brazil, CEP:20220-400.
| | - Fernando Luiz Dias
- Head and Neck Surgery Department, Brazilian National Cancer Institute (INCA), Hospital do Câncer I, Praça da Cruz Vermelha, 23 - 6°andar, Rio de Janeiro, RJ, Brazil, CEP:20230-130.
| | - Denise de Abreu Pereira
- Serviço de Hematologia, Laboratório de Genética Aplicada, Brazilian National Cancer Institute (INCA), Hospital do Câncer I, Praça da Cruz Vermelha, 23 - 6° andar, Rio de Janeiro, RJ, Brazil, CEP: 20230-130.
| | - Russolina B Zingali
- Rede Proteômica do Rio de Janeiro, Rio de Janeiro, Brazil; Laboratório de Hemostase e Venenos e Unidade de Espectrometria de Massas e Proteômica, Instituto de Bioquímica Médica, Programa de Biologia Estrutural, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, CCS Bloco H2 sala 04, Cidade Universitária, Rio de Janeiro, RJ, Brazil, CEP 21941-902.
| | - Gilda Alves
- Serviço de Hematologia, Laboratório de Genética Aplicada, Brazilian National Cancer Institute (INCA), Hospital do Câncer I, Praça da Cruz Vermelha, 23 - 6° andar, Rio de Janeiro, RJ, Brazil, CEP: 20230-130.
| | - Simone Queiroz Chaves Lourenço
- Oral Pathology, Federal Fluminense University (UFF), R. Marques de Paraná, 303/4° andar (Hospital Universitário Antônio Pedro), Centro Niterói, Brazil, CEP: 24033-900.
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Mogedas-Vegara A, Hueto-Madrid JA, Chimenos-Küstner E, Bescós-Atín C. Oral leukoplakia treatment with the carbon dioxide laser: A systematic review of the literature. J Craniomaxillofac Surg 2016; 44:331-6. [PMID: 26920045 DOI: 10.1016/j.jcms.2016.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 12/21/2015] [Accepted: 01/27/2016] [Indexed: 10/22/2022] Open
Abstract
We conducted a systematic review of the literature to evaluate treatment of oral leukoplakia with the carbon dioxide (CO2) laser. A comprehensive search of studies published between 1981 and 2015 and listed in the PubMed (National Library of Medicine, NCBI) database yielded 378 articles which were screened in detail. Relevant studies were selected according to predetermined inclusion and exclusion criteria. A total of 33 articles met the final inclusion criteria and were analysed in detail in accordance with the PRISMA-P statement. These full-text papers were classified as synopses (n = 7), recurrence and malignant transformation studies (n = 17), comparative studies between CO2 laser and cold knife surgery (n = 3) and studies evaluating the efficacy of CO2, Nd:YAG and KTP lasers. According to the literature the CO2 laser is the workhorse of oral leukoplakia treatment due to its effectiveness and low associated morbidity. However, randomized clinical trials are needed to compare CO2 laser with other lasers. The results of our systematic review showed that there is no consensus regarding the factors involved in higher recurrence and malignization rates, so further studies are needed.
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Affiliation(s)
- Alfonso Mogedas-Vegara
- Oral and Maxillofacial Department, Vall D'Hebron University Hospital, Universidad Autónoma de Barcelona, Passeig de la Vall D'Hebron 119-129, 08035 Barcelona, Spain.
| | - Juan-Antonio Hueto-Madrid
- Oral and Maxillofacial Department, Vall D'Hebron University Hospital, Universidad Autónoma de Barcelona, Passeig de la Vall D'Hebron 119-129, 08035 Barcelona, Spain
| | - Eduardo Chimenos-Küstner
- Oral Medicine, Oral Pathology, Oral Surgery Department, Universidad de Barcelona, Feixa Llarga s/n, L'Hospitalet Ll., 08907 Barcelona, Spain
| | - Coro Bescós-Atín
- Oral and Maxillofacial Department, Vall D'Hebron University Hospital, Universidad Autónoma de Barcelona, Passeig de la Vall D'Hebron 119-129, 08035 Barcelona, Spain
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Kalavrezos N, Scully C. Mouth Cancer for Clinicians Part 6: Potentially Malignant Disorders. ACTA ACUST UNITED AC 2016; 42:866-8, 871-4, 877. [PMID: 26749794 DOI: 10.12968/denu.2015.42.9.866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED 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.
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Yanik EL, Katki HA, Silverberg MJ, Manos MM, Engels EA, Chaturvedi AK. Leukoplakia, Oral Cavity Cancer Risk, and Cancer Survival in the U.S. Elderly. Cancer Prev Res (Phila) 2015; 8:857-63. [PMID: 26159805 DOI: 10.1158/1940-6207.capr-15-0091] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/05/2015] [Indexed: 11/16/2022]
Abstract
Screening for oral leukoplakia, an oral cavity cancer (OCC) precursor, could lead to earlier detection of OCC. However, the progression rate from leukoplakia to OCC and the benefits of leukoplakia screening for improving OCC outcomes are currently unclear. We conducted a case-cohort study of U.S. adults ages ≥65 years in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linkage. We identified leukoplakia diagnoses through Medicare claims, and OCC diagnoses through SEER cancer registries. Weighted Cox regression was used to estimate leukoplakia associations with OCC incidence, and the absolute OCC risk following leukoplakia diagnosis was calculated. Among OCC cases, we compared OCC stage and OCC survival between cases with a prior leukoplakia diagnosis versus those without prior leukoplakia. Among 470,266 individuals in the SEER-Medicare subcohort, 1,526 (0.3%) had a leukoplakia diagnosis. Among people with leukoplakia, the cumulative OCC incidence was 0.7% at 3 months and 2.5% at 5 years. OCC risk was most increased <3 months after leukoplakia diagnosis (HR, 115), likely representing the diagnosis of prevalent cancers. Nonetheless, risk remained substantially increased in subsequent follow-up [HR ≥ 3 months, 24; 95% confidence interval (CI), 22-27; HR ≥ 12 months, 22, 95% CI, 20-25]. Among OCC cases (N = 8,927), those with prior leukoplakia were less likely to be diagnosed at regional/distant stage (OR, 0.36; 95% CI, 0.30-0.43), and had lower mortality (HR, 0.74; 95% CI, 0.65-0.84) when compared with OCC cases without a prior leukoplakia. Individuals with leukoplakia have substantially elevated risk of OCC. Lower stage and better survival after OCC diagnosis suggest that leukoplakia identification can lead to earlier OCC detection and reduced mortality.
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Affiliation(s)
- Elizabeth L Yanik
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - M Michele Manos
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Anil K Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Del Corso G, Gissi DB, Tarsitano A, Costabile E, Marchetti C, Montebugnoli L, Foschini MP. Laser evaporation versus laser excision of oral leukoplakia: A retrospective study with long-term follow-up. J Craniomaxillofac Surg 2015; 43:763-8. [DOI: 10.1016/j.jcms.2015.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 01/10/2023] Open
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The treatment of oral leukoplakia with the CO2 laser: A retrospective study of 65 patients. J Craniomaxillofac Surg 2015; 43:677-81. [PMID: 25913630 DOI: 10.1016/j.jcms.2015.03.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 01/21/2015] [Accepted: 03/18/2015] [Indexed: 02/04/2023] Open
Abstract
The use of CO2 laser has become a routine procedure for the treatment of oral leukoplakia. In this retrospective study, we evaluated 65 patients with oral leukoplakia treated with CO2 laser vaporization. The main location was the tongue (n = 21/65, 32.3%). The initial biopsy showed mild/moderate dysplasia in almost half the patients (n = 29, 44.6%) and hyperplasia without dysplasia in around a third of the patients (n = 21, 32.3%). The recurrence and malignant transformation rates were 33.8% (n = 22) and 15.4% (n = 10), respectively. The follow-up mean (standard deviation) was 15.0 (10.6) months. The procedure-related complications rate was 7.7% (n = 5). The Kaplan-Meier curves for time to recurrence showed differences only for gingiva lesions compared to tongue lesions (log rank, p = 0.032). Malignant leukoplakia transformation is independent of treatment, although it seems advisable to treat leukoplakia with or without dysplasia.
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26
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Pentenero M, Meleti M, Vescovi P, Gandolfo S. Oral proliferative verrucous leucoplakia: are there particular features for such an ambiguous entity? A systematic review. Br J Dermatol 2015; 170:1039-47. [PMID: 24471527 DOI: 10.1111/bjd.12853] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2014] [Indexed: 12/31/2022]
Abstract
Proliferative verrucous leucoplakia (PVL) is a distinct, particularly aggressive form of oral leucoplakia. Given the low prevalence of PVL, data are sparse and are mostly from case reports, case series and only a few case-control studies, meaning that the literature is able to provide only weak evidence. The present systematic literature review aims to collate the available evidence on the following issues: patient demographics, aetiology, lesion location(s), malignant potential, location and histopathological features of transformed lesions, disease-specific survival rates and treatment response. Electronic databases were searched for studies in the English language reporting original data from at least 10 patients with PVL on the target issues of the present review. The retrieved data were merged and a descriptive analysis performed. The 20 studies selected indicated that PVL does not seem to be correlated with the major risk factors for oral carcinoma (tobacco, alcohol and/or areca nut/betel leaf chewing). The disorder affects mainly adult/elderly women and has a very high malignant transformation rate, particular site distribution and particular location and histopathological features of transformed lesions. The present results may be limited by some articles being unintentionally excluded as they were not found during the electronic search, a lack of worldwide accepted diagnostic criteria for PVL, and overlapping data from multiple studies performed in a limited number of centres. Despite these potential drawbacks, the present results demonstrate that PVL does have particular features.
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Affiliation(s)
- M Pentenero
- Unit of Oral Medicine and Oral Oncology, Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy
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van der Waal I. Oral potentially malignant disorders: is malignant transformation predictable and preventable? Med Oral Patol Oral Cir Bucal 2014; 19:e386-90. [PMID: 24905952 PMCID: PMC4119315 DOI: 10.4317/medoral.20205] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 01/14/2023] Open
Abstract
Leukoplakia is the most common potentially malignant disorder of the oral mucosa. The prevalence is approximately 1% while the annual malignant transformation ranges from 2% to 3%. At present, there are no reliable clinicopathological or molecular predicting factors of malignant transformation that can be used in an individual patient and such event can not truly be prevented. Furthermore, follow-up programs are of questionable value in this respect. Cessation of smoking habits may result in regression or even disappearance of the leukoplakia and will diminish the risk of cancer development either at the site of the leukoplakia or elsewhere in the mouth or the upper aerodigestive tract.
The debate on the allegedly potentially malignant character of oral lichen planus is going on already for several decades. At present, there is a tendency to accept its potentially malignant behaviour, the annual malignant transformation rate amounting less than 0.5%. As in leukoplakia, there are no reliable predicting factors of malignant transformation that can be used in an individual patient and such event can not truly be prevented either. Follow-up visits, e.g twice a year, may be of some value.
It is probably beyond the scope of most dentists to manage patients with these lesions in their own office. Timely referral to a specialist seems most appropriate, indeed.
Key words:Oral potentially malignant disorders, oral leukoplakia, oral lichen planus.
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Affiliation(s)
- Isaäc van der Waal
- VU Medical Center, Department of Oral and Maxillofacial, Surgery/Pathology and Academic Centre for Dentistry, (ACTA), Amsterdam, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands, i.vander
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Pedrosa A, Santos A, Ferreira M, Araújo C, Barbosa R, Medeiros L. Is carbon dioxide laser vaporization a valuable tool in the management of oral leukoplakia? A survey at an oncology hospital. Lasers Med Sci 2014; 30:1629-30. [PMID: 24570088 DOI: 10.1007/s10103-014-1551-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
Affiliation(s)
- A Pedrosa
- Department of Dermatology and Venereology, Centro Hospitalar São João EPE, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal,
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Brouns EREA, Baart JA, Karagozoglu KH, Aartman IHA, Bloemena E, van der Waal I. Malignant transformation of oral leukoplakia in a well-defined cohort of 144 patients. Oral Dis 2013; 20:e19-24. [DOI: 10.1111/odi.12095] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 11/30/2022]
Affiliation(s)
- EREA Brouns
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - JA Baart
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - KH Karagozoglu
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - IHA Aartman
- Department of Social Dentistry and Behavioural Sciences; Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - E Bloemena
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
- Department of Pathology; VU University Medical Center (VUmc); Amsterdam The Netherlands
| | - I van der Waal
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
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