Laser therapy decreases oral leukoplakia recurrence and boosts patient comfort: a network meta-analysis and systematic review

BACKGROUND

Oral leukoplakia (OLK) is a prevalent precancerous lesion with limited non-pharmacological treatment options. Surgery and various lasers are the mainstay of treatment; however, their relative efficacy and optimal choice remain unclear. This first network meta-analysis compared the effects of different lasers and surgical excision on post-treatment recurrence and comfort in OLK patients.

METHODS

We searched four databases for relevant randomized controlled trials (RCTs) up to April 2023. The primary outcome was post-treatment recurrence, and secondary outcomes included intraoperative hemorrhage and postoperative pain scores. The Cochrane Risk of Bias tool was used to assess the study quality. Meta-analysis and network meta-analysis were employed to determine efficacy and identify the optimal intervention.

RESULTS

A total of 11 RCTs including 917 patients and 1138 lesions were included. Er,Cr:YSGG laser treatment showed significantly lower recurrence rates compared to CO2 laser (OR: 0.04; 95% CI: 0.01-0.18), CO2 laser with margin extension (OR: 0.06; 95% CI: 0.01-0.60), Er:YAG laser (OR: 0.10; 95% CI: 0.03-0.37), electrocautery (OR: 0.03; 95% CI: 0.00-0.18), and standard care (OR: 0.08; 95% CI: 0.02-0.33). Er,Cr:YSGG laser also ranked the best for reducing recurrence, followed by standard care and CO2 laser combined with photodynamic therapy (PDT). Er:YAG and Er:Cr:YSGG lasers minimized bleeding and pain, respectively. None of the interventions caused severe adverse effects.

CONCLUSION

For non-homogeneous OLK, Er:YAG, Er:Cr:YSGG, and CO2 laser combined with PDT offer promising alternatives to surgical excision, potentially reducing recurrence and improving patient comfort. Further high-quality RCTs are necessary to confirm these findings and determine the optimal laser-PDT combination for OLK treatment.

Compositional and functional changes in the salivary microbiota related to oral leukoplakia and oral squamous cell carcinoma: a case control study

BACKGROUND

Oral squamous cell carcinoma (OSCC) is one of the most common malignant tumours with increasing incidence, and oral leukoplakia (OLK) has a strong tendency to undergo malignant transformation. The oral microbiota may influence oral cancer progression, but the salivary bacterial composition and functional changes in OSCC and OLK have not been comprehensively elucidated. Therefore, we compared salivary bacteria in OLK and OSCC patients with healthy controls (HC).

METHODS

Metagenomic sequencing was used to compare the bacterial composition and functional changes of 18 OSCC patients, 21 OLK patients and 21 HC. Spearman correlation was used to identify possible associations between functions and bacteria.

RESULTS

Gemella was the most differentially enriched genus in OSCC. At the species level, Streptococcus sp. NPS 308, Streptococcus agalactiae, Gemella haemolysans and Gemella morbillorum were slightly increased in OLK and OSCC. Kyoto Encyclopedia of Genes and Genomes (KEGG) results showed that OSCC was mainly associated with metabolism functions, including lipid metabolism, carbohydrate metabolism and glycan biosynthesis and metabolism. The synthesis and degradation of ketone bodies, cysteine and methionine metabolism and glycerolipid metabolism differed significantly among the three groups, and were highest in OSCC and lowest in HC. And G. haemolysans was significantly associated with these selected metabolic pathways.

CONCLUSIONS

Metagenomic analysis revealed significant differences in the salivary microbiota among OSCC, OLK and HC. Thus, salivary microbiota composition and functional changes may be associated with OSCC progression. Metabolism of nonessential amino acids such as cysteine and methionine in bacteria may play an important role in oral oncogenesis, and more studies of the mechanism between metabolisms of bacteria and oral oncogenesis are needed in the future.

Impact of Case Based Learning on Teaching of Undergraduate Oral Pathology Course

BACKGROUND

Oral Pathology curriculum is taught as didactic lectures which promotes rote learning. This study intends to introduce and assess the impact of Case based Learning in student's performance and to obtain the perception of students towards it.

METHODS

This cross-sectional study was conducted from March 2021 to January 2022 among dental undergraduate students (N=25) of Gandaki Medical College, Pokhara. The syllabus of Potentially Malignant Oral Lesions and Oral Cancer were covered for BDS third year students by didactic lectures, followed by Case Based Learning sessions (session I- Oral Leukoplakia, session II- Oral Squamous Cell Carcinoma). A pre-test and post-test, containing Multiple Choice questions relevant to the topics, were administered before and after the interventions. Students' perceptions were collected using feedback questionnaire. The scores obtained in the pre and post-test were compared by Wilcoxon pair test and Mann Whitney U test. The level of significance was set at p <0.05.

RESULTS

Twenty and 21 students participated in session I and II respectively, and all (100%) of them felt that the case scenarios made the subject more interesting, and 19 (90.5%) students felt more such sessions should be added and be used along with lectures. Post test score after case-based learning was significantly higher (For Oral Leukoplakia p=0.028, for Oral Squamous Cell Carcinoma p<0.001) in comparison to didactic lectures.

CONCLUSIONS

As case-based learning was positively perceived and preferred along with lectures, an attempt to incorporate it along with lectures in clinically important topics should be made.

[The mechanism of scutellarin inhibiting oral leukoplakia carcinogenesis based on network pharmacology and in vitro cytology]

PURPOSE

To investigate the potential mechanisms of scutellarin on oral leukoplakia (OLK) by network pharmacology and further verify by cytology.

METHODS

The potential targets of scutellarin acting on OLK were excavated through network pharmacology. PPI network was constructed, and the possible targets and pathways of scutellarin were predicted by GO and KEGG enrichment analysis. CCK-8 and Transwell assays were used to verify the effects of scutellarin on proliferation, migration and invasion of Leuk-1 and Cal-27 cell lines. The expression of related molecules was detected by Western blot to explore potential molecular mechanisms. Statistical analysis was performed with GraphPad Prism 9 software package.

RESULTS

There were 29 potential targets of scutellarin acting on OLK, of which HIF-1α was the key target, and the results of GO and KEGG analysis showed that scutellarin was highly involved in the response of cells and tissues to hypoxia and influenced HIF-1 signaling pathway. Scutellarin can significantly inhibit the proliferation (IC50:2 mmol/L), invasion and migration of Leuk-1 and Cal-27 cells(P＜0.05), and downregulated the expression of HIF-1α in Leuk-1 and Cal-27 cells.

CONCLUSIONS

Scutellarin can inhibit carcinogenesis of OLK by suppressing HIF-1 signaling pathway.

Oral erythroplakia and oral erythroplakia-like oral squamous cell carcinoma - what's the difference?

BACKGROUND

Oral erythroplakia (OE) is a rare oral potentially malignant disorder, that has a high rate of malignant transformation. The definition of OE still lacks uniformity. In particular, lesions that look clinically like erythroplakias, but are histopathologically diagnosed as squamous cell carcinomas are still sometimes called erythroplakias. The purpose of this study is to present demographic and clinicopathologic features of a series of OEs and clinically oral erythroplakia -like squamous cell carcinomas (OELSCC), to study their differences and to discuss the definition of OE.

METHODS

A multicenter retrospective case series of OEs and OELSCCs. Descriptive statistics were used to analyze the data.

RESULTS

11 cases of OEs and 9 cases of OELSCCs were identified. The mean age of the OE patients was 71 years and 72.7% were female, while the mean age of the OELSCC patients was 69 years, and all were female. 9% of the OE and 22% of the OELSCC patients had smoked or were current smokers. 72.7% of the OEs and 55.5% of OELSCCs were uniformly red lesions. 63.6% of the OE and 22% of the OELSCC patients had a previous diagnosis of oral lichenoid disease (OLD). The malignant transformation rate of OE was 9% in a mean of 73 months.

CONCLUSIONS

OE and OELSCC may arise de novo or in association with OLD. Tobacco and alcohol use were not prevalent in the present cases. The clinical features of OEs and OELSCC are similar, but symptoms, uneven surface and ulceration may be more common in OELSCCs than in OEs. Clinical recognition of OE is important since it may mimic other, more innocuous red lesions of the oral mucosa. The diagnosis of OE requires biopsy and preferably an excision. Clarification of the definition of OE would aid in clinical diagnostics.

Emerging Role of Decoy Receptor-2 as a Cancer Risk Predictor in Oral Potentially Malignant Disorders

The aim of this study was to evaluate the expression of the senescence markers, Decoy Receptor 2 (DcR2) and Differentiated Embryo-Chondrocyte expressed gen 1 (DEC1), in oral potentially malignant disorders (OPMDs) to ascertain their possible association with oral cancer risk. The immunohistochemical analysis of DcR2 and DEC1 expression (along with p16 and Ki67 expression) was carried out in 60 patients with clinically diagnosed oral leukoplakia. Fifteen cases (25%) subsequently developed an invasive carcinoma. Correlations between protein marker expression, histological grade and oral cancer risk were assessed. DcR2, DEC1 and Ki67 protein expressions were found to correlate significantly with increased oral cancer risk, and also with an increased grade of dysplasia. Multivariate analysis demonstrated that DcR2 and Ki67 expression are independent predictors of oral cancer development. Our results evidence for the first time the potential of DcR2 as an early biomarker to assess oral cancer risk in patients with oral leukoplakia (HR = 59.7, p = 0.015), showing a superior predictive value to histology (HR = 4.225, p = 0.08). These findings reveal that the increased expression of DcR2 and DEC1 occurred frequently in OPMDs. In addition, DcR2 expression emerges as a powerful biomarker for oral cancer risk assessment in patients with oral leukoplakia.

The global prevalence of oral leukoplakia: a systematic review and meta-analysis from 1996 to 2022

BACKGROUND

Oral leukoplakia(OLK) is a common oral potentially malignant disorder. The global prevalence of solely OLK was published in 2003, while the prevalence varied among different studies. In recent years, large-scale summary and definition-related analyses obtain insufficient attention. This study aimed to perform a systematic review of prevalence studies of oral leukoplakia and assess predisposing factors of its occurrence.

METHODS

The search terms ("Oral leukoplakia" OR OLK OR leukoplakia) AND (prevalence OR incidence OR epidemiology) were searched in databases (Pubmed, Embase, Scopus, and Web of Science) for OLK studies published from January 1996 until December 2022. The estimated prevalence calculation and risk of bias analysis used STATA 16.0.

RESULTS

We obtained 69 studies, including 1,263,028 participants, from 28 countries, and 6 continents. The prevalence was 1.39%, varying from 0.12 to 33.33%. The overall pooled estimated prevalence of OLK was 2.23% for population-based studies, 1.36% for clinic-based population studies, and 9.10% for specific populations. The pooled prevalence in different continents ranged from 0.33 to 11.74% with a statistical difference in the population-based calculation. The estimated prevalence of OLK was higher in males than in females. Those who smoked and consumed alcohol had a higher prevalence than those who did not.

CONCLUSION

Combining data from 69 published studies, the prevalence of OLK was determined as 1.39% and the pooling estimated global prevalence was 3.41%. The prevalence was relatively consistent and stable across different continents and different definitions. A higher pooled estimated prevalence was found among males, those aged over 60 years old, smokers, and alcohol consumers. The results from the included studies in this systematic review revealed that the prevalence was relatively consistent and stable across various definitions and continents, which may help in developing global treatment and prevention strategies for oral leukoplakia.

[Differences in biochemical indexes and AIDS-related complications at baseline in HIV- infected patients with different levels of immune reconstitution after antiretroviral therapy]

Objective: To observe the differences in biochemical indexes and AIDS-related complications at baseline in HIV-infected patients with different levels of immune reconstitution to antiretroviral therapy (ART). Methods: The subjects were treat-naïve adult HIV-infected patients who were followed up for more than 24 months in the Guangzhou Eighth People's Hospital affiliated infection clinic at Guangzhou Medical University from January 2010 to December 2017. CD4+ T lymphocyte count at baseline at <200, 200-350, and >350 cells/µl levels were divided into poor, partial, and good immune reconstitution groups. The Kruskal-Wallis H and chi-square tests were used to analyze the differences in baseline sociodemographic characteristics, biochemical indexes, and AIDS-related complications among different groups. The SPSS 20.0 software was used for statistical analysis. Results: Among the 3 900 HIV-infected individuals, 385 cases (9.9%), 1 206 cases (30.9%), and 2 309 cases (59.2%) were grouped into poor, partial and good immune reconstitution groups, respectively. The baseline biochemical indexes of leukocyte, platelet, hemoglobin, TG, TC, FPG, AST, ALT and total bilirubin in the poor immune reconstitution group were significantly different from those in the good immune reconstitution group (all P<0.05). The proportion of AIDS-related complications at baseline in the poor immune reconstitution group, such as tuberculosis, pneumocystis yeli pneumonia, disseminated mycosis, esophageal candidiasis, extrapulmonary tuberculosis, dermatitis, oral candidiasis, oral mucous leukoplakia, continuous diarrhea for more than 1 month and continuous or intermittent fever for more than 1 month, was significantly higher than that in the good immune reconstitution group (all P<0.05). Conclusions: The biochemical indexes and AIDS-related complications in HIV-infected patients with different levels of immune reconstitution were significantly different at baseline. Attention should be paid to monitoring abnormal biomedical indicators and AIDS-related complications at baseline.

Biomarkers of malignant transformation in oral leukoplakia: from bench to bedside

Oral leukoplakia is a common precursor lesion of oral squamous cell carcinoma, which indicates a high potential of malignancy. The malignant transformation of oral leukoplakia seriously affects patient survival and quality of life; however, it is difficult to identify oral leukoplakia patients who will develop carcinoma because no biomarker exists to predict malignant transformation for effective clinical management. As a major problem in the field of head and neck pathologies, it is imperative to identify biomarkers of malignant transformation in oral leukoplakia. In this review, we discuss the potential biomarkers of malignant transformation reported in the literature and explore the translational probabilities from bench to bedside. Although no single biomarker has yet been applied in the clinical setting, profiling for genomic instability might be a promising adjunct.

Macrophages CD163+ and Factor XIIIa+ Provide a First-Line Defence against Proliferative Verrucous Leukoplakia Antigens

This study aimed to evaluate the density of the dendritic cells (DCs) and macrophages in oral leukoplakia (OL) and proliferative verrucous leukoplakia (PVL) by immunohistochemical analysis. We analysed paraffined tissue samples of PVL (n = 27), OL (n = 20), and inflammatory fibrous hyperplasia (n = 20) as the control group using the immunomarkers for DCs (CD1a, CD207, CD83, CD208 and CD123) and macrophages (CD68, CD163, FXIIIa and CD209). A quantitative analysis of positive cells in the epithelial and subepithelial areas was determined. Our results showed a reduction in CD208+ cells in the subepithelial area of the OL and PVL compared to the control. Additionally, we found a higher density of FXIIIa+ and CD163+ cells in the subepithelial area in PVL compared to the OL and control. Four-way MANOVA revealed a relationship between increased CD123+ cell density in the subepithelial area of “high-risk” samples regardless of disease. Macrophages provide the first line of defence against PVL antigens, suggesting a distinct pattern of innate immune system activation in PVL compared to OL, which may contribute to the complexity and the high rate of malignant transformation in the PVL.

On the Oral Microbiome of Oral Potentially Malignant and Malignant Disorders: Dysbiosis, Loss of Diversity, and Pathogens Enrichment

The role of dysbiosis in the development and progression of oral potentially malignant disorders (OPMDs) remains largely unknown. Here, we aim to characterize and compare the oral microbiome of homogeneous leucoplakia (HL), proliferative verrucous leukoplakia (PVL), oral squamous cell carcinoma (OSCC), and OSCC preceded by PVL (PVL-OSCC). Fifty oral biopsies from HL (n = 9), PVL (n = 12), OSCC (n = 10), PVL-OSCC (n = 8), and healthy (n = 11) donors were obtained. The sequence of the V3-V4 region of the 16S rRNA gene was used to analyze the composition and diversity of bacterial populations. In the cancer patients, the number of observed amplicon sequence variants (ASVs) was lower and Fusobacteriota constituted more than 30% of the microbiome. PVL and PVL-OSCC patients had a higher abundance of Campilobacterota and lower Proteobacteria than any other group analyzed. A penalized regression was performed to determine which species were able to distinguish groups. HL is enriched in Streptococcus parasanguinis, Streptococcus salivarius, Fusobacterium periodonticum, Prevotella histicola, Porphyromonas pasteri, and Megasphaera micronuciformis; PVL is enriched in Prevotella salivae, Campylobacter concisus, Dialister pneumosintes, and Schaalia odontolytica; OSCC is enriched in Capnocytophaga leadbetteri, Capnocytophaga sputigena, Capnocytophaga gingivalis, Campylobacter showae, Metamycoplasma salivarium, and Prevotella nanceiensis; and PVL-OSCC is enriched in Lachnospiraceae bacterium, Selenomonas sputigena, and Prevotella shahii. There is differential dysbiosis in patients suffering from OPMDs and cancer. To the best of our knowledge, this is the first study comparing the oral microbiome alterations in these groups; thus, additional studies are needed.

Malignant transformation of oral potentially malignant disorders in Taiwanese indigenous peoples: A nationwide retrospective cohort study

Malignant transformation of oral potentially malignant disorders (OPMDs) is a potential cause of oral cancer. Currently, there is no research investigating the rate of malignant transformation of OPMDs into oral cancer in indigenous Taiwanese peoples. This study aimed to retrospectively investigate whether ethnicity (indigenous vs non-indigenous people) plays a role in increasing the malignant transformation rate of OPMDs into oral cancer. This study used data from the oral mucosal screening database and the Cancer Registry File, both of which originated from the National Health Insurance Research Database. We matched the baseline characteristics to control for confounding factors between indigenous peoples and non-indigenous peoples (17,768 indigenous subjects vs 71,072 non-indigenous subjects; 1:4 match) and compared the 2 cohorts. After matching for confounding factors such as age, sex, habits, and OPMD subtype, the malignant transformation rate was not statistically higher for indigenous people than for non-indigenous people. We also discovered that indigenous people with oral verrucous hyperplasia might have a higher chance of malignant transformation into oral cancer than the non-indigenous cohort. We conclude that ethnicity is not a risk factor for the malignant transformation of OPMDs into oral cancer; however, indigenous people with oral verrucous hyperplasia need to pay special attention and are suggested to undergo regular follow-ups for the occurrence of oral cancer.

[Agreement evaluation of the severity of oral epithelial dysplasia in oral leukoplakia]

Objective: To evaluate the inter-observer agreement of the severity of oral epithelial dysplasia in oral leukoplakia, providing a theoretical basis for the development of a more objective grading system. Methods: This study included 60 digital pathological slides of oral leukoplakia from Oral Medicine Department of West China Hospital of Stomatology, Sichuan University, and 239 tissue microarray images of oral leukoplakia from State Key Laboratory of Oral Diseases, Sichuan University, to evaluate the agreement of grading. Besides, 1 000 patches were generated from the 60 digital pathological slides and were divided into 500 small-sized patches (224 pixel×224 pixel) and 500 large-sized patches (1 024 pixel×1 024 pixel), to evaluate the agreement of feature detection. Gradings and feature detections were completed by three pathological experts from the oral pathology departments of two Grade 3, Class A stomatological hospitals in China. Kappa coefficient was used to quantify the inter-observer agreement among pathologists. Results: Minimal agreement was found in the grading of oral epithelial dysplasia among pathologists (Kappa=0.30 in the pathological slide group, Kappa=0.30 in the tissue microarray group). None agreement was found in feature detection within the small-sized patches group (median Kappa=0.14 for architectural features, median Kappa=0.18 for cytological features), and minimal agreement was found in feature detection within the large-sized patches group (median Kappa=0.25 for architectural features, median Kappa=0.25 for cytological features). Conclusions: Generally, the agreement of grading and feature detection of oral epithelial dysplasia in oral leukoplakia is poor. Development of a more objective grading system of oral epithelial dysplasia based on artificial intelligence may be helpful to improve the agreement.

Deciphering the pharmacological mechanisms of Scutellaria baicalensis Georgi on oral leukoplakia by combining network pharmacology, molecular docking and experimental evaluations

BACKGROUND

Oral leukoplakia (OLK), an uncharacterized pathological condition that occurs as a white patch in the oral mucosa, is the most common precancerous condition. Scutellaria baicalensis Georgi (SBG) is a medicinal plant with a wide range of pharmacological effects. Increased evidence shows that SBG has potential therapeutic effects on OLK. However, the therapeutic mechanisms of SBG against OLK have not yet been completely elucidated.

PURPOSE

This study aimed to clarify the active components and multi-target mechanisms of SBG against OLK via network pharmacology, molecular docking and experimental evaluations.

STUDY DESIGN AND METHODS

The active components and related targets of SBG were screened by the TCMSP database and Swiss Target Prediction database. Potential therapeutic targets of OLK were collected using the GeneCards and OMIM databases. Then, we established protein-protein interaction (PPI), compound-target-disease (C-T-D), and compound-target-pathway (C-T-P) networks by Cytoscape to identify the main components, core targets, and pharmacological pathways of SBG against OLK via applying data mining techniques and topological parameters. Metascape database was utilized for GO and KEGG pathway analysis. Molecular docking techniques were used to estimate the binding force between the components and the hub genes. Subsequently, a series of in vitro experiments, specifically CCK-8 assay, clone formation assay, wound healing assay, flow cytometry, RT-qPCR and western blotting were conducted for further verification.

RESULTS

There were 25 active components and 31 related target genes in SBG against OLK. PPI analysis showed that Akt1, VEGFA, EGFR, HIF1A and PTGS2 shared the highest centrality among all target genes. KEGG pathway analysis found that PI3K-Akt signaling pathway may occupy core status in the anti-OLK system. Molecular docking results showed that the main active components of SBG had a strong binding affinity to the hub genes. In vitro experiments showed that the leading component baicalein may inhibit proliferation, block cells in the S phase, induce DOK cell apoptosis, and downregulate the mRNA expression of 5 hub genes by inhibiting PI3K/Akt signaling pathway activation.

CONCLUSION

The most predominant component of SBG against OLK was baicalein and the key pathway was PI3K/Akt. The main components and hub genes had robust binding abilities. In vitro experiments showed that baicalein could inhibit the proliferation of DOK cells, induce apoptosis, block the cell cycle, and inhibit the mRNA expression level of the hub genes by inhibiting the PI3K/Akt pathway.

Diverse Pathological Findings of Interstitial Lung Disease in a Patient with Dyskeratosis Congenita

A 42-year-old man with a history of surgery for tongue cancer was referred to our hospital due to an abnormal chest shadow. High-resolution computed tomography showed lower lobe reticulation. A physical examination revealed nail dystrophy, oral leukoplakia, and reticulated hypopigmentation. Lung biopsy revealed subpleural and perilobular fibrosis, suggestive of usual interstitial pneumonia. However, multiple pathological findings, including homogenous fibrosis and cell infiltration in the centrilobular region, which were compatible with nonspecific interstitial pneumonia, and bronchiolitis were also seen. Genetic testing showed a hemizygous missense mutation in the DKC1 gene, and the patient was diagnosed with dyskeratosis congenita. Although anti-fibrotic therapy was initiated, the patient's respiratory function has continued to decrease.

[Study of salivary metabonomics in patients with oral squamous cell carcinoma and leukoplakia]

PURPOSE

The objective of this study was to detect and analyze the existence of differential metabolites from saliva of patients with oral squamous cell carcinoma(OSCC) by metabonomics method, and to evaluate its application value on clinical diagnosis or screening of OSCC.

METHODS

The collected saliva samples for OSCC patients, oral leukoplakiac(OLK) patients who were pathologically diagnosed and met the inclusion criteria were analyzed using metabonomics methods (GC-TOF-MS). The results were analyzed by principal component analysis and orthogonal partial least squares discriminant analysis using SIMCA software.

RESULTS

The metabolic profiles of OSCC, OLK and healthy control group showed significant differences (P<0.05). In total, 15 typical differential metabolites among the three groups were detected. Further study focusing on metabolic pathway revealed imbalance of protein, energy and lipid metabolism between OSCC and OLK patients. Abnormal tricarboxylic acid cycle was detected as well.

CONCLUSIONS

Metabonomics methods is feasible for differential metabolites analysis,15 differential metabolites were detected in OSCC,OLK patients and healthy people. These findings will contribute to the early screening of oral squamous cell carcinoma.

[A Case of Malignant Transformation of Previously Diagnosed Oral Leukoplakia]

Oral leukoplakia is the most common premalignant and potentially malignant lesion of the oral mucosa. Several studies have reported that the prevalence of oral cancer in young people is increasingly rapidly. The patient in this report was a 47- year-old man who complained of left tongue discomfort. At the first visit, the clinical diagnosis was oral leukoplakia, and a follow-up examination was planned with a view to partial resection. However, at the follow-up, biopsy revealed squamous cell carcinoma. He underwent partial resection. Two months after the surgery, metastasis to the lymph node was detected. The patient underwent radical neck dissection and concurrent chemoradiotherapy. At the 3-years follow-up, there was no sign of recurrence or metastasis.

Oral Potentially Malignant Disorders

Oral potentially malignant disorders (OPMDs) are precursor lesions that may undergo malignant transformation to oral cancer. These lesions most commonly present clinically as white patches (leukoplakia). However, they may also be red (erythroplakia), or red and white (erythroleukoplakia). There are many risk factors associated with the development of an OPMD, and with the risk of malignant transformation of the lesion. A biopsy with subsequent microscopic examination from the lesional tissue is necessary in identification of OPMD. This article reviews the clinical appearance of OPMDs, associated risk factors, diagnosis and histologic appearance, and treatment.

[Potentially malignant disorders of the oral mucosa]

Potentially malignant disorders of the oral mucosa. The term "precancerous" is now abandoned in favor to « potentially malignant disorder » which provide a better view of the evolution a far from systematic. Of these disorders, leukoplakia is the most common while erythroplakia is rare. Their diagnoses are still defined by exclusion of other known white or red lesions. Despite progress in molecular biology, there is no marker enabling to predict malignant transformation. When feasible, excision of these lesions is recommended, irrespective of the presence or the absence of dysplasia, a pure histologic notion. It is unknown if such removal can really prevent the development of a squamous cell carcinoma. The risk of malignant transformation of oral lichen planus, lower than in leukoplakia, is better known. There is no therapeutic enabling to prevent such event. Other potentially malignant disorders such as oral submucous fibrosis, actinic cheilitis, lupus and immunodeficiency conditions are rare.

Characteristics and trends of oral leukoplakia research: A bibliometric study of the 100 most cited articles

BACKGROUND

Bibliometric analysis highlights the key topics and studies which have shaped the understanding and management of a disease of interest. Here the top-cited articles on oral leukoplakia (OL) were characterized, and research patterns and trends were analyzed.

METHODS

A comprehensive search was performed and identified in the Scopus database up to 22 February 2019 for the 100 most-cited articles on OL.

RESULTS

The number of citations of the 100 selected articles varied from 116 to 1418, with a mean of 226.7 citations per article. Both Journal of Oral Pathology and Medicine and Oral Surgery Oral Medicine Oral Pathology Oral Radiology were journals with the most articles published (n = 10). Both Hong W.K. and Lippman S. were the most frequently contributing authors (n = 9). United States (n = 43) and M.D. Anderson Cancer Center (n = 12) was most contributing country and institution, respectively. Systematic reviews/meta-analysis (n = 3) and randomized controlled trial (n = 7) were study designs with high evidence level. It is noteworthy that the majority of high-quality articles were the research of chemopreventive drugs (n = 21) and molecular markers/targets (n = 10), which may indicate a trend of key topics.

CONCLUSIONS

The results of this first citation analysis of the most-cited articles on OL provide a historical perspective on scientific evolution, and suggest further research trends and clinical practice in the field of OL.

Insight on the relationship of ABO blood grouping associated with oral premalignant lesions, conditions and inherited oral cancer syndromes

BACKGROUND

Risk factors such as chronic use of tobacco, smoking and alcohol consumption of individual's lifestyle may possibly influence the significant role in the etiopathogenesis of precancerous lesions (PL) and Conditions (PC) and lead to oral cancer. Previous studies have revealed that genetic factors have contributed to a remarkable extent in the development of this chronic disease. Limited studies have confirmed that ABO blood groups remain reportedly possible genetic factor to the specific disease such as oral malignant. In this context, we have reported that individuals in a particular blood group are more prone to develop lesions and certain types of cancer. This has thrown a light to take up an effort to conduct this present study.

MATERIALS AND METHODS

The present study covering 105 patients and grouped into three subjects with 35 participants in each. a) oral squamous cell carcinoma b) oral leukoplakia and c) submucous fibrosis. Gender and age group impact was also made to understand the interaction between the focused sample groups. A separate control was gathered from a same geographical population composed of gender-matched healthy volunteers. Slide agglutination was employed for blood grouping and results were tabulated for statistical analysis.

RESULTS

Blood group "A" exhibited a significant relationship between oral squamous cell carcinoma patient and odd ratio shown 1.74 times higher risk of developing oral cancer. Gender different and habit stimulation have increased the risk. A significant relationship was observed between ABO blood group and oral leukoplakia and oral submucous fibrosis.

CONCLUSION

Study inferred that blood group "A" is found to be at the high risk in developing oral malignant syndrome due to its susceptibility, whereas oral pre-cancer is hypothesized that individual habits are the host risk factor and transformed to carcinoma by interacting genetic factors to act upon ABO blood group.

Oral health consequences of smokeless tobacco use

Smokeless tobacco (SLT) use has many oral effects including oral cancer, leukoplakia and erythroplakia, oral submucous fibrosis (if mixed with areca nut), loss of periodontal support (recession) and staining of teeth and composite restorations. This review was aimed to provide information to identify oral lesions that occur due to the use of smokeless tobacco so that effective interventions can be undertaken to reduce morbidity and mortality from the use of SLT.

Prevalence of oral cancer, oral potentially malignant disorders and other oral mucosal lesions in Cambodia

OBJECTIVES

To obtain data on the prevalence of oral mucosal lesions (OMLs) among Cambodians, and to assess the relationship between known risk habits of oral diseases with prevalence of oral potentially malignant disorders (OPMDs).

DESIGN

This was a population-based, cross-sectional study whereby subjects were adults aged 18 years old and above. A workshop on the identification of OML was held to train and calibrate dental officers prior to data collection in the field. Sociodemographic and risk habits data were collected via face-to-face interview, whilst presence of OML and clinical details of lesions such as type and site were collected following clinical oral examination by the examiners. Data analysis was carried out using the Statistical Package for Social Science (SPSS) version 12.0. The association between risk habits and risk of OPMD was explored using logistic regression analysis.

RESULTS

A total of 1634 subjects were recruited. Prevalence of OML for this population was 54.1%. Linea alba was the most common lesion seen (28.7%). This study showed an overall OPMD prevalence of 5.6%. The most common type of OPMD was leukoplakia (64.8%), followed by lichen planus (30.8%). Subjects who only smoked were found to have an increased risk for OPMD of almost four-fold (RR 3.74, 95%CI 1.89-7.41). The highest risk was found for betel quid chewers, where the increased risk observed was more than six times (RR 6.75, 95%CI 3.32-13.72). Alcohol consumption on its own did not seem to confer an increased risk for OPMD, however when practiced concurrently with smoking, a significant risk of more than five times was noted (RR 5.69 95%CI 3.14-10.29).

CONCLUSION

The prevalence of OML was 54.1%, with linea alba being the most commonly occurring lesion. Smoking, alcohol consumption and betel quid chewing were found to be associated with the prevalence of OPMD, which was 5.6%.

Limited evidence for interventions to treat oral leukoplakia

Data sourcesCochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline Ovid, Embase, Ovid, CancerLit via PubMed. MetaRegister of Controlled Trials, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched for ongoing trials.The reference lists of included studies and existing reviews were manually searched.Study selectionRandomised control trials (RCTs) including patients diagnosed with oral leukoplakia comparing any treatment to placebo or no treatment were included with no restrictions on language or date of publication.Data extraction and synthesisTwo reviewers independently checked for inclusion, performed data extraction using a specially designed form, and assessed the risk of bias for each study and by domain over all studies. The primary outcome considered was onset of oral cancer reported as dichotomous data. Secondary outcomes were clinical resolution, histological changes and adverse events that were mostly reported as ordinal data.ResultsFourteen studies with 909 participants were included in the review. Of the included studies, four compared topical interventions to placebo, nine compared systemic interventions to placebo, and one compared a combination of topical and systemic treatments versus placebo. The risk of bias was considered to be low in one study, unclear in seven, and high for the remaining six. Only three studies provided usable data on the primary outcome: cancer incidence. Clinical improvement was achieved in three studies using: systemic vitamin A or retinoids (two studies) and systemic beta-carotene or carotenoids (one study). Only two studies using beta-carotene or carotenoids were meta-analysed, showing no benefit on the outcome cancer development.ConclusionsThere is no evidence that any of the active treatments included work better than placebo in reducing the risk of developing oral cancer.

Oral precursor lesions and malignant transformation--who, where, what, and when?

Oral potentially malignant disorders (PMD) are recognisable mucosal conditions that have an unpredictable risk of transformation to squamous cell carcinoma (SCC), a lethal and deforming disease of rising incidence. Contemporary management is based on clinical recognition of suspicious lesions and incisional biopsy to enable histopathological assessment and grading of dysplasia, together with excision of high-risk lesions and long-term surveillance. However, it is impossible to predict clinical outcome or risk of malignant transformation. Our aim was to evaluate the relevance of previously identified oral precursor lesions for the development of SCC and staging of disease. We therefore retrospectively reviewed 1248 cases of SCC diagnosed in oral and maxillofacial surgery units at Newcastle upon Tyne and Sunderland hospitals between 1996 and 2009. Of them, 58 identifiable precursor lesions became malignant but only 25 had been dysplastic on initial biopsy; 19 of 33 non-dysplastic lesions exhibited lichenoid inflammation only. SCC arose most often on the ventrolateral tongue and floor of the mouth, with a mean transformation time of 29.2 months. Transformation time was significantly shorter in men (p=0.018) and those over 70 years of age (p=0.010). Patients who consumed more than 21 units of alcohol/week and those who had had interventional laser surgery to treat precursor lesions, had higher-staged tumours (p=0.048). Although retrospective, this study shows that the results of incisional biopsy and grading of dysplasia have limited use as predictive tools, and supports the view that cancer may arise in the absence of recognisable epithelial dysplasia. Our findings confirm the importance of clinical vigilance and active surveillance in the management of all patients with clinically suspicious oral lesions, irrespective of the histological findings.

[Expression of Ki-67 and P53 protein in oral squamous cell carcinoma and its clinical significance]

PURPOSE

To investigate the clinical and pathological features and its relationship with the expression of Ki-67 and p53 protein in oral squamous cell carcinoma.

METHODS

Immunohistochemical SP staining method was used to quantify the protein expression levels of Ki-67 and p53 protein in 10 cases of normal oral mucosa, 16 cases of oral leukoplakia (OLK) tissue, and 48 cases of oral squamous cell carcinoma. The relationship of the expression of Ki-67 and p53 protein to clinical and pathological data was analyzed, and SPSS17.0 software package was used for statistical analysis.

RESULTS

The positive expression rate of Ki-67 protein in normal oral mucosa, oral leukoplakia and oral squamous cell carcinoma was 30%, 56.3% and 79.2%, respectively; The positive expression rate of p53 was 0%, 43.8%, and 70.8%, respectively; Ki-67 and p53 expression had significant difference among normal oral mucosa, oral leukoplakia and oral squamous cell carcinoma (P<0.05); The expression of Ki-67 protein was significantly elevated with tumor stage, differentiation and cervical lymph node metastasis (P<0.05); The expression of p53 protein was significantly related to the degree of tumor differentiation (P<0.05); The expression of Ki-67 and p53 was positively correlated in oral squamous cell carcinoma (P<0.05).

CONCLUSIONS

The high expression of Ki-67 and p53 protein in oral squamous cell carcinoma tissues may play an important role in the development of oral squamous cell carcinoma.

[A retrospective analysis on the malignant transformation rate, time and risk factors of oral leukoplakia]

PURPOSE

A retrospective analysis was made on the oral leukoplakia (OLK) patients archived from 1978 to 2009 at the Department of Oral Medicine, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University, to analyze the malignant transformation of oral leukoplakia and its influential factors.

METHODS

The data was studied with the SAS6.12 software package, using the methods of survival analysis and Cox regression to acquire malignant transformation rate (MTR) and malignant transformation time (MTT).

RESULTS

According to the archived files, there were 576 cases of OLK with 350 males and 226 females. Among them, 66 cases (33 males and 33 females) developed OSCC, the total MTR was 11.46%. Two hundred and sixty-seven cases were suitable for survival analysis and Cox regression. The 1-year MTR was (0.40 ± 0.40)%, (0.86 ± 0.61)% (life-table method/product-limit method); the 2-year MTR went up to (2.84 ± 1.15)%, (2.93 ± 1.18)% and the 5-year MTR was as high as (11.28 ± 2.70)%, (11.31 ± 2.71)%. In Cox regression model, location of lesion and age were the main factors that affected OLK's transformation to OSCC.

CONCLUSIONS

The MTR of OLK is related to the follow-up time; The lesion site and age are the most important risk factors. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality (08DZ2271100), Shanghai Leading Academic Discipline Project (S30260) and Research Fund of Shanghai Municipal Education Commission (JDY-07061).

[Expression and its relationship of murine double minute 2 and P53 protein in oral leukoplakia and squamous cell carcinoma]

OBJECTIVE

To study the expression and its relationship of murine double minute 2 (MDM2), P53 protein in oral leukoplakia and squamous cell carcinoma.

METHODS

Immunohistochemical assay was used to detect the expression of MDM2 and P53 proteins in 15 normal oral epithelium tissues, 24 cases of oral leukoplakias and 41 cases of oral squamous cell carcinomas.

RESULTS

There were no positive expression of MDM2 and P53 in normal mucosa. With significantly difference compared with the normal group (P < 0.05), the positive rates of MDM2 and P53 were 58.3%, 75.6% and 37.5%, 68.3% in oral leukoplakia and squamous cell carcinoma. MDM2-positive rate had no significant difference (P > 0.05), while P53-positive rate was significant difference (P < 0.05) compared with oral leukoplakia and oral squamous cell carcinoma. Two kinds of indicators for further correlation analysis showed that MDM2 and P53 protein showed a positive correlation relationship both in oral leukoplakia (P = 0.018) and oral squamous cell carcinoma (P = 0.000).

CONCLUSION

The expression of MDM2 in oral leukoplakia and oral squamous cell carcinoma suggests that this gene may play a significant role in the process of carcinogenesis of oral squamous cell carcinoma. The correlation of MDM2 and P53 expression indicates that both of them may play a synergistic role in the process of carcinogenesis of oral squamous cell carcinoma.

[Application of Cochrane systematic reviews in diagnosis and treatment for oral mucosal diseases]

OBJECTIVE

To collect evidence in diagnosis and treatment of oral mucosal diseases.

METHODS

The Cochrane library (Issue 3, 2009) was searched to get the full texts of published related Cochrane systematic reviews. The results were summarized for recommendation to dentists. The current status of evidence based medicine in this field was analyzed.

RESULTS

Reliable evidence for management of oral submucous fibrosis is still limited; amifostine, hydrolytic enzymes, ice chips and Chinese medicine may be effective in preventing oral mucositis for patients with cancer receiving radiotherapy or chemotherapy; the evidence in treating oral mucositis with allopurinol mouthwash, granulocyte macrophage-colony stimulating factor, immunoglobulin or human placentral extract for patients with cancer receiving treatment is weak and unreliable yet; there is evidence that acyclovir is efficacious in prevention and treatment of herpes simplex virus infections in patients being treated for cancer; there is strong evidence that drugs absorbed or partially absorbed from the gastrointestinal tract prevent oral candidiasis in patients receiving treatment for cancer; relapses and adverse effects are common in using beta carotene, lycopene, vitamin A or retinoids to treat oral leukoplakia; only some weak evidence is provided in using cyclosporines, retinoids, steroids or phototherapy for treating oral lichen planus; the evidence about acyclovir for treating primary herpetic gingivostomatitis is insufficient; there is little research evidence for treatment of burning mouth syndrome.

CONCLUSION

It is essential to raise the quality of design and conduction of clinical trials in the field of oral mucosal disease to provide solid bases for systematic review, so that to improve evidence based treatment of these diseases.

Diagnostic evaluation and management of hoarseness

Hoarseness is a common symptom that can result from a wide spectrum of underlying causes ranging from the common cold to a malignancy. A framework for diagnostic evaluation is presented based on categorizing the myriad of causes by how they interfere with the voice production mechanism. Triaging of cases by necessity or urgency of laryngoscopy is assisted by forming a global index of suspicion based on targeted history taking. Laryngoscopy is required in most cases to obtain a diagnosis for the hoarseness. Treatments commonly prescribed for hoarseness are critically examined in this article. To listen to audio clips of patients with different types of hoarseness, please visit our website, www.medical.theclinics.com.

[Near infrared Raman spectral character and diagnostic value of squamous cell carcinoma of oral mucosa]

OBJECTIVE

To evaluate the value of the near infrared Raman spectroscope in diagnosing oral squamous cell carcinoma (OSCC).

METHODS

Near infrared Raman spectra of ten normal mucosa, twenty OSCC and thirty oral leukoplakia (OLK) cases were collected in the research. Based on the previous researches, the information of the subtracted spectra of compared group was gained by the characteristic band in them. A Gaussian radial basis function support vector machine was used to classify spectra and establish the diagnostic models. The efficacy and validity of the algorithm were evaluated.

RESULTS

By analyzing the subtracted mean spectra, the increasing peak intensity in wavenumber range of 500-2 200 cm(-1) hinted us of the high contents of DNA, protein and lipid in OSCC, which elucidate the high proliferative activity. The increasing peak intensity in the wavenumber range of 500-2 200 cm(-1) hinted us of the high contents of DNA, protein and lipid in OSCC, which elucidate the high proliferative activity, but the difference between OLK and OSCC was not as much as that between normal and OSCC. The Gaussian radial basis function support vector machine showed powerful ability in grouping and modeling of normal and OSCC, and the specificity, sensitivity and accuracy were 100%, 97.44% and 98.81% correspondingly. The algorithm showed good ability in grouping and modeling of OLK and OSCC, the specificity, sensitivity and accuracy were 95.00%, 86.36% and 96.30%.

CONCLUSION

Combined with support vector machines, near infrared Raman spectroscopy could detect the biochemical variations in oral normal, OLK and OSCC, and establish diagnostic model accurately.

[Expression of Notch1 and epidermal growth factor receptor in human tongue squamous cell carcinoma and precancerous lesion]

OBJECTIVE

To investigate the expression of Notch1 in human tongue squamous carcinoma (TSCC) and precancerous lesion, and to explore the potential relation between Notch1 and epidermal growth factor receptor (EGFR).

METHODS

The expression of Notch1 and EGFR was detected in human TSCC (n = 41), tongue leukoplakia (LP) (n = 39) and normal tongue mucosa (n = 7) by immunohistochemistry.

RESULTS

In normal tongue mucosa and LP, the positive staining of Notch1 was mainly distributed in stratum corneum, partially in stratum granulosum and stratum spinosum, but not in stratum basale, while the positive staining of EGFR was mainly distributed in stratum basale, rarely in stratum spinosum, but not in stratum granulosum and stratum corneum. In TSCC, Notch1 expression was mainly distributed in locations of squamous metaplasia, but not in peripheral cells of carcinomas, while EGFR expression was detected mainly in peripheral cells of carcinomas, but not in locations of squamous metaplasia.

CONCLUSION

Notch1 promotes the differentiation of epithelial cells in tongue mucosa and acts as a tumor suppressor in TSCC. EGFR may act as a negative regulator of Notch1 expression in epithelium of tongue mucosa and TSCC, for maintaining cell proliferation and promoting the tumorigenesis and progression of TSCC.

[Biologic analysis of recombinant human adenovirus-p53 injection in patients with oral leukoplakia ]

OBJECTIVE

Advances in tumor biology and clinical trials indicate that p53 transfer is an alternative therapy for head and neck squamous cell carcinoma. The aim of this study is to evaluate the biologic activity of multiple intraepithelial injections of Ad-p53 in patients with dysplastic oral leukoplakia, which is the most common premalignant lesion of the oral squamous cell carcinoma.

METHODS

From 2006 to 2007, 18 Chinese patients clinically and histopathologically diagnosed as dysplastic oral leukoplakia were recruited for this study. On a 15-day cycle, intraepithelial injections of Ad-p53 were administered once every three days at dose levels dependent upon lesion size/dose escalation sequence (1 x 10(8) vp). 24-48 h after the last injection, incisional biopsy were performed, and immunohistochemistry was used to examine the protein expression of P53 and P21(CIP/WAF).

RESULTS

In the postreatment patients, P53 protein and P21(CIP/WAF) protein expression were significantly enhanced (100%, 89.9%, respectively) and statistical analysis revealed the expression of P53 protein had a positive correlation with that of P21(CIP/WAF) protein (r=0.598, P<0.01).

CONCLUSION

Intraepithelial injections of gendicine is biologically active in patients with dysplastic oral leukoplakia. It may be a promising treatment for oral leukoplakia.

[Role of ataxia telangiectasis mutated in the oncogenesis of oral squamous cell carcinoma]

OBJECTIVE

To investigate the role of ataxia telangiectasis mutated (ATM) gene in the oncogenesis and progression of oral squamous cell carcinoma (OSCC).

METHODS

A total of 61 formalin-fixed and paraffin-embedded samples were obtained from patients with hyperkeratosis, oral leukoplakia, OSCC and normal healthy controls. The expression of ATM protein in all of the samples was investigated by streptavidin-peroxidase immunohistochemistry assay. PCR was also performed to detect the loss of heterozygosity (LOH) in D11s2179 of ATM gene. The correlations between ATM and the clinical and histopathological characteristics were also investigated.

RESULTS

The results indicated that the ATM expression was increased in oral premalignant lesions (P<0.05). For OSCC, 68.8% samples showed normal or increased ATM expression, while 31.3% had decreased or absent ATM expression. Significant differences were found between the group of decreased or absent ATM expression and that of normal or increased expression over the histopathological grade and lymph node metastasis state. PCR results displayed that none of the samples from oral premalignant lesions showed abnormal changes, while 3 of the OSCC (9.38%) showed loss of heterozygosity (LOH) and 2 (6.25%) with microsatellite instability (MSI). Those 3 samples of LOH showed absent ATM expression.

CONCLUSION

These findings indicated that the over expression of ATM may contribute to prevent carcinogenesis of OSCC. ATM inactivation may be one of the genetic alterations of the molecular progression of OSCC.

[A case report on canceration of proliferative verrucous leukoplakia]

Proliferative verrucous leukoplakia (PVL) is a particular form of oral leukoplakia clinically characterized by chronic proliferation, multiple occurrence, and intractability. It is seen mostly among elderly women and often involves bucca, palate, gingiva and tongue. Its canceration rate is very high. This article reports a case of a middle-aged woman with progressive PVL which became focally malignant who complained about buccal and palatal exophytic white patches, and discusses the possible pathogenic mechanism, diagnosis, treatment, prognosis of PVL and differentiation between PVL and other types of oral leukoplakia by way of reviewing relevant literature.

Expression of viral and human dUTPase in Epstein-Barr virus-associated diseases

Deoxyuridine triphosphatase (dUTPase) catalyses the hydrolysis of dUTP to dUMP and pyrophosphate thus preventing the incorporation of uracil into replicating DNA. Previous studies of several virus models have suggested that viral dUTPases may be required for virus replication in resting cells whereas in proliferating cells cellular dUTPase may substitute for a mutant viral protein. Using monoclonal antibodies and immunohistochemistry, Epstein-Barr virus-associated non-neoplastic and neoplastic diseases were studied for the expression of viral and human dUTPases. Oral hairy leukoplakia, an AIDS-associated lesion of the tongue, is known to support EBV replication in the upper epithelial cell layers. In agreement with this, strong focal expression of EBV dUTPase was detected in the upper epithelial cell layers of oral hairy leukoplakia whereas expression of human dUTPase was confined to the basal proliferative cell compartment. Furthermore, in infectious mononucleosis tonsils, rare scattered small lymphoid cells expressed EBV dUTPase, consistent with the expression pattern of other EBV lytic cycle antigens. These findings are in agreement with the notion that EBV replicates in resting cells. Three EBV-associated tumours, Hodgkin lymphoma, Burkitt lymphoma and nasopharyngeal carcinoma, lacked detectable expression of EBV dUTPase, in agreement with the notion that EBV infection is largely latent in these tumours. By contrast, expression of human dUTPase was observed regularly in these tumours. These results suggest that EBV dUTPase may be a suitable target for anti-viral therapy and that inhibitors of human dUTPase should prove useful for the treatment of human tumours, including EBV-associated cancers.

Laryngeal precancer: a review of the literature, commentary, and comparison with oral leukoplakia

Laryngeal keratosis (LK) is a precancerous mucosal change with great similarity to oral leukoplakia. Its malignant transformation rate varies from 1% to 40%, with the highest rates being found in patients microscopically diagnosed as "keratosis with atypia" (KWA). Recent evidence indicates that even cases with only mild or moderate epithelial dysplasias are at increased risk for malignant transformation, with the highest rates occurring in patients with more severe dysplasia or carcinoma in situ. Approximately 81% of LK patients are men and the average age at diagnosis is 50 years, a decade younger than that for laryngeal carcinoma patients. A high proportion of LK patients are tobacco smokers (84%) and alcohol abusers (at least 35%). LK is almost always found on the true vocal cords and is usually bilateral (67%). Clinical signs of high risk include, in decreasing order of importance: erythroplakia, surface granularity, increased keratin thickness, increased size, recurrence after conservative removal, and long duration. The annual incidence of LK in the United States is 10.2 and 2.1 lesions per 100,000 males and females, respectively.

[Hairy leukoplakia: current concepts]

Current data about oral hairy leukoplakia are reported. Clinical manifestations, histological and ultrastructural features and pathogenic mechanisms are firstly described. Then diagnosis are exposed. Finally, management is discussed.