Premalignancy 3 / dental implant courses by Indian dental academy

Premalignant
Lesions & Conditions
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

LEARNING OBJECTIVES
At the end of the lecture student should be able to
– Illustrate classification, incidence, etiology, clinical
features, histopathological features of
–Carcinoma in situ
– Erythroplakia
– Leukoedema
– Stomatitis nicotina
– Actinic cheilosis actinic keratosis

Carcinoma in situ
(Intraepithelial Carcinoma)
• Commonly on skin & mucosa
• Two schools of thought
– Precancerous dyskeratotic process
– Laterally spreading, intraepithelial carcinoma

• Chandler Smith Concept
– The term carcinoma in situ does not reveal
that the lesion is a cancer now but has not yet
become invasive, or whether it is not a cancer
now but will become a cancer at some later
time,
– Metastasis IMPOSSIBLE
– Bowen’s disease is a special form of intra
epithelial carcinoma.

Clinical features
• Clinical appearance of leukoplakia, erythroplakia, or a
combination
• Ulcerated lesion, white and ulcerated lesion, red and
ulcerated lesion
• Floor of the mouth, tongue, lips
• Males > Females

Histological features
– Irregular epithelial
stratification
– Loss of polarity of basal cells
– Basilar hyperplasia
– Increased number of mitosis
– Abnormally superficial mitosis
– Premature keratinization in
single cells (Dyskeratosis)
– Keratin pearls within rete
ridges
– Abnormal variation in nuclear size
(Anisonucleosis)
– Nuclear pleomorphism (variation in
nuclear shape)
– Abnormal variation in cell size
(Anisocytosis)
– Cellular pleomorphism (variation in
cellular shape)
– Increased nuclear cytoplasmic ratio
– Increased nuclear size
– Atypical mitotic figures
– Increased number and size of nucleoli
Hyperchromasia

Treatment & Prognosis
• No uniformly accepted treatment
• Surgical excision
• Electrocautery
• Cryosurgery
• Laser ablation
• Dealt in severe cases like carcinoma

Leukoedema
• Filmy opalescence of the mucosa in early stages to a
more definite grayish white appearance with coarse
wrinkled surface
• Bilateral lesions
• Buccal mucosa extending onto the lips
• Most noticeable along the occlusal line in the bicuspid
and molar region www.indiandentalacademy.com

• Unknown etiology
• Average age of occurrence 45 years
• Intracellular edema of spinous cell layer, broad rete
pegs, edematous cells
• Clinical significance-
• Lesion disappears on stretching of mucosa which
is diagnostic.
• No treatment requiredwww.indiandentalacademy.com

Erythroplakia
• Red patch that cannot be diagnosed clinically or
pathologically as any other diagnosable disease
• Originally described by Queyrat in 1911 as a
precancerous lesion of the genital area.
• All true erythroplakic lesions demonstrate significant
epithelial dysplasia, carcinoma in situ, or invasive
squamous cell carcinoma.

Clinical Features
• 1.2 / 1,00,000 (2.0 in Males & 0.5 in Females)
• Erythroplakia may occur in conjunction with
leukoplakia
• Elderly males 65 to 74 years
• Floor of mouth, tongue, soft palate are common
sites

Classification
• Shear has classified Erythroplakia as
– Homogenous form which appears as well
demarcated erythematous plaque or macule with a
soft, velvety texture, common on buccal mucosa
and soft palate.
– Erythroplakia interspersed with patches of
leukoplakia in which erythematous areas are
irregular and often not as bright red, common on
tongue, floor of the mouth

• Soft, red lesions that are slightly elevated with
an irregular outline and a granular or finely
nodular surface speckled with tiny white plaques
(Speckled erythroplakia)

Histopathology
• 90% of the lesions are either severe epithelial
dysplasia, carcinoma in situ, superficial invasive
squamous cell carcinoma
• Lack of keratin production
• Treatment should be done depending on
histopathological report
• Long term follow up is suggested

Stomatitis nicotini, Nicotine
stomatitis, Smoker’s Palate
• Less common as reduction in cigar and pipe smoking
• Although associated with smoking but less malignant
potential
• Response to heat rather than chemicals in tobacco
• Reverse smoking with hand rolled cigarettes

Clinical features
• Men > 45 years
• Diffusely gray/white palatal mucosa
• Elevated papules with punctated red center,
representing inflamed salivary glands
• Brown stain on teeth
• Palatal keratin may impart dried mud appearancewww.indiandentalacademy.com

Histopathology & Treatment
• Hyperkeratosis
• Acanthosis
• Chronic inflammation of subepithelial connective
tissue and mucous glands
• Rare epithelial dysplasia
• Completely reversible
• Cessation of habit

Actinic keratosis
• Premalignant lesion caused due to UV rays
• Lesion develops on skin of more than 50% all white
adults
• 15 % for older men, 6 % for women, increased
prevalence with age
• One in one thousand transforms into malignancy

Clinical features
• Seldom before 40 years
• Face & neck, Dorsum of hands, Scalp of bald headed
men, Forearms
• Irregular scaly plaques varying in color from normal to
white, gray, brown.
• Presence of keratin horn
• Few mm to cm

Histopathology
• Hyperkeratosis
• Acanthosis
• Tear drop shaped rete ridges
• Dysplasia
• Suprabasilar acantholysis
• Chronic inflammatory cells

Treatment & Prognosis
• Electrocautery
• Cryosurgery
• Laser ablation
• Topical application of 5 Fluorouracil
• Curettage
• Recurrence rare but new lesion arise in sun damaged
skin

Actinic Cheilosis (Actinic
Chelitis)
• Lower lip alteration due to long term exposure to UV
rays
• Light complexioned people with a tendency to sunburn
• Also known as Sailor’s Lip or Farmer’s Lip
• Seldom seen below 45 years

• Atrophy of the lower lip vermilion border, characterized
by pale surface and blotchy areas
• Blurring of the margin between the cutaneous portion
and vermilion zone is seen
• Chronic focal ulcerations develop later
• Atrophic epithelium
• Dysplasia

• Electrocautery
• Cryosurgery
• Laser ablation
• Use of sunscreens
• OSCC transformation

Summary
Classification, incidence, etiology, clinical features,
histopathological features of carcinoma in situ,
erythroplakia.,
leukoedema, stomatitis nicotina, actinic cheilosis actinic
keratosis.

Premalignancy 3 / dental implant courses by Indian dental academy

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