what are the potentially malignant disorders in the oral cavity?

1. (Potentially)
Malignant
Disorders in OC
By Mehrdad Ghanbari

2. INTRODUCTION
Most cancerous lesions are derived from
potentially malignant oral disorders (PMOD).
The World Health Organization (WHO)
points out the following lesions as the main
PMOD: leukoplakia, erythroplakia, actinic
cheilitis, submucous fibrosis, and lichen
planus. As far as we know no attempt has
been made to classify oral PMDs till date, a
possible classification could be:

3. Classification
High Risk Infections
Immunodeficiency Inherited Disorders
Life-Style Related
01 02 03
04 05

4. High Risk
01

5. Erythroplakia is defined as ‘any lesion of the oral mucosa that presents as bright
red velvety plaques which cannot be characterized clinically or pathologically
as any other recognizable condition’. Such lesions are usually irregular in
outline, although clearly demarcated from adjacent normal epithelium. The
surface may be nodular. In some cases erythroplakia coexists with areas
of leukoplakia. The incidence of malignant change in erythroplakias is 17
times higher than that in leukoplakia. In nearly every case of erythroplakia
there are areas of epithelial dysplasia, carcinoma-in-situ or invasive
carcinoma. Clearly all erythroplakic areas must be completely excised, either
surgically or with a CO2 laser, and the specimens submitted for careful
histological examination.
Erythroplakia

7. Leukoplakia is a condition in which one or more white patches or spots (lesions)
forms inside the mouth.
Leukoplakia is different from other causes of white patches such as thrush or
lichen planus because it can eventually develop into oral cancer. Within 15
years, about 3% to 17.5% of people with leukoplakia will develop squamous cell
carcinoma, a common type of skin cancer.
The likelihood of developing cancer from leukoplakia depends on the size, shape,
and appearance of abnormal cells.
There are two main types of leukoplakia:
Homogenous: A mostly white, evenly colored thin patch that may have a smooth,
wrinkled, or ridged surface that is consistent throughout.
Non-homogenous: A mainly white or white-and-red, irregularly shaped patch that
may be flat, nodular (having protrusions), or verrucous (elevated). Additional
sub-classifications, such as ulcerated and nodular (speckled), may also be
made, and can help predict the likelihood that a patch will become cancerous.
Leukoplakia

9. Oral submucous fibrosis is a chronic, complex, premalignant (1%
transformation risk) condition of the oral cavity, characterized by
juxta-epithelial inflammatory reaction and progressive fibrosis of the
submucosal tissues (the lamina propria and deeper connective
tissues). As the disease progresses, the oral mucosa becomes fibrotic
to the point that the person is unable to open the mouth. The
condition is remotely linked to oral cancers and is associated
with areca nut and / or its by-products chewing, majorly practiced in
South and South-East Asian countries. The incidence of OSMF has
also increased in the western countries due to the changing habits
and constant migrating population.
Oral Submucous Fibrosis (OSF)

11. Erosive lichen planus is a rare form of lichen planus that can last a
long time. It causes painful ulcers to develop in the mouth and in the
genital areas of both males and females. In some cases, long-term
erosive lichen planus can increase the chance of some types of
cancer developing.
Erosive Lichen Planus

12. Life-Style
Related
02

13. Smokeless tobacco keratosis (STK)[4] is a condition which develops on
the oral mucosa (the lining of the mouth) in response to smokeless
tobacco use. Generally it appears as a white patch, located at the
point where the tobacco is held in the mouth. The condition usually
disappears once the tobacco habit is stopped. It is associated with
slightly increased risk of mouth cancer.
Smokeless Tobacco Keratosis

14. Stomatitis nicotina is a diffuse white patch on the hard palate, usually
caused by tobacco smoking, usually pipe or cigar smoking. It is
painless, and it is caused by a response of the palatal oral mucosa to
chronic heat. A more pronounced appearance can occur
with reverse smoking, sometimes distinguished from stomatitis
nicotina by the term reverse smoker's stomatitis. While stomatitis
nicotina that is caused by heat is not a premalignant condition, the
condition that is caused by reverse smoking is premalignant.
Reverse Smoker’s Palate

16. Actinic cheilitis, also known as solar cheilosis, farmer’s lip, or sailor’s lip, is
a reaction to long-term sun exposure on the lips, primarily the lower
lip. The lip is especially susceptible to UV radiation because it has a
thinner epithelium and less pigment. Some believe actinic cheilitis
represents a type of actinic keratosis and is therefore premalignant.
Others believe it is a form of in-situ squamous cell carcinoma.
Regardless, the literature is in agreement that its presence indicates
an increased risk for invasive squamous cell carcinoma.
Actinic Cheilitis

18. Infections
03

19. Chronic hyperplastic candidiasis (CHC), earlier known as
candidal leukoplakia, is a variant of oral candidiasis that
classically presents as a white patch on the
commissures of the oral mucosa and it is mostly caused
by Candida albicans. Clinically, the lesions are usually
asymptomatic and regress after appropriate antifungal
therapy and correction of the underlying cause. If the
lesions are untreated, a small portion may develop
dysplasia and later progress into carcinoma.
Hyperplastic Candidialis

21. A viral disease of the oral cavity is the infectious type of pathology
affecting oral tissues. Viral diseases may either occur due to cellular
destruction or consequence of immune reaction following viral
proteins. Viral infections typically present with abrupt onset and
association of solitary or multiple blister or ulcerations. Concomitant
general symptoms such as fever, malaise, and lymphadenopathy are
observed in a few viral conditions. Viral infections are also linked to
the development and progression of periodontal diseases. A viral
disease of oral tissues is often encountered in dental practice,
however, limited attention is given in diagnosis and management
due to diagnostic challenges. Certain viral infections are associated
with tumor formation.
Viral (HPV, HIV, EBV, HBV, HSV)

22. Tertiary syphilis may develop quickly or the
latency period can be up to a decade. This is
a very serious condition. If syphilis is not
treated in the early stages, it can cause
severe complications.
Tertiary syphilis can affect multiple organ
systems, including CNS involvement, heart
failure, aneurysms of the ascending aorta,
blood vessels, ocular involvement,
granulomatous lesions, “gumma,” and
several other oral manifestations.
Tertiary Syphilis

23. Immunodeficiency
04

24. The Oral Cavity PMD’s Relevant to Immunodeficiency are classified into 3 categories as
follows:
- Because of Solid Organ Transplantation in Oral Cavity
- Graft versus Host diseases in Oral Cavity
- And Chronic Cutaneous Lupus Erythematous: This form is characterized by
inflammatory, scarring lesions mainly involving the head or neck, but also
elsewhere, mostly on the photoexposed areas. The typical lesions in chronic discoid
lupus erythematosus appear as round or oval erythematous plaques with scales
and follicular plugging. These plaques are well demarcated and spread
peripherally. On the face, they can form a butterfly-like rash involving the cheeks
and nose. The long-standing lesions are atrophic and scarring, sometimes with
hypo-, and hyperpigmentation and teleangiectasias. In 50% of the patients, there is
a widespread skin involvement. This form is considered to be the typical clinical
picture of CCLE.

25. Inherited
Disorders
05

26. Xeroderma pigmentosum (XP) is a hereditary condition characterized by
extreme sun sensitivity, leading to a very high risk of skin cancer and
other medical problems.
People with XP are extremely sensitive to ultra-violet (UV) radiation from
the sun. This includes UV type A and UV type B. Exposure to even a
very small amount of UV radiation leads to severe sunburn and
blistering, beginning at a very young age. The sensitivity to UV
radiation results in increased freckling, as well as areas of lighter skin
pigmentation. They may also have very dry skin. There is a high risk of
squamous cell and basal cell skin cancers and melanoma.
Xeroderma Pigmentosum (XP)

28. Dyskeratosis congenita is a rare genetic disorder that results from
progressive failure of the bone marrow. It presents with a classic triad
of reticular pigmentations of the skin, dystrophic nails, and oral
leukoplakia; patients rarely develop cancers. We report a patient with
dyskeratosis congenita who presented with squamous cell
carcinoma of the oral tongue.
Dyskeratosis Congenita

30. Epidermolysis bullosa (EB) represents a spectrum of conditions that are
characterized by blistering and mechanical fragility of the skin. the
craniofacial and oral manifestations of the different EB types vary
markedly in both character and severity depending largely on the EB
type.5, 6 The tissues affected and the phenotypes displayed in affected
individuals are closely related to the specific abnormal or absent
proteins resulting from the causative genetic mutations for these
disorders.
Epidermolysis Bullosa

32. Bloom syndrome (BSyn) is a rare genetic
disorder characterized by short
stature; a sun-sensitive, red rash that
occurs primarily over the nose and
cheeks; mild immune deficiency with
increased susceptibility to infections;
insulin resistance that resembles type
2 diabetes; and most importantly, a
markedly increased susceptibility to
many types of cancer, especially
leukemia, lymphoma and
gastrointestinal tract tumors.
Bloom syndrome

33. Background Fanconi anemia (FA) is a rare autosomal recessive disorder
characterized by a high degree of genomic instability and
predisposition to cancer development. Recent evidence suggests
that the incidence of head and neck squamous cell carcinoma
(HNSCC) may be increased in patients with FA.
Fanconi’s Anemia