Epithelial dysplasia of the oral mucosa—Diagnostic problems and prognostic features

Summary Many oral cancers are preceded by potentially malignant lesions, which may appear as white or red patches on the oral mucosa. In the absence of validated molecular markers, the histological grading of oral epithelial dysplasia remains the only determinant of potential malignant change. Grading is notoriously unreliable, with wide intra- and inter-observer variability. However, conformity may be achieved between pathologists using similar standards and some objective criteria can be used for diagnosing and grading dysplasia. Oral dysplasia is graded simply as mild, moderate or severe, by an evaluation of a combination of cytological and architectural changes in the oral epithelium. Mild epithelial dysplasia, shows relatively few cytological aberrations involving only the lower third of the epithelium, while at the other end of the scale, severe dysplasia may show significant cytological atypia extending into the involved upper third of the epithelium. At its worst, dysplasia involves the full thickness of the epithelium and may be designated carcinoma in situ. This review describes the clinical and histopathological features of oral epithelial dysplasia and guides the pathologist on diagnosis and key prognostic factors.

[1]  P. Speight,et al.  Oral epithelial dysplasia: clinical characteristics of western European residents. , 2003, Oral oncology.

[2]  K. Schepman,et al.  Malignant transformation of oral leukoplakia: a follow-up study of a hospital-based population of 166 patients with oral leukoplakia from The Netherlands. , 1998, Oral oncology.

[3]  M. Gorsky,et al.  Oral leukoplakia and malignant transformation. A follow‐up study of 257 patients , 1984, Cancer.

[4]  L. Kurland,et al.  Carcinoma in situ of the upper aerodigestive tract. Incidence, time trends, and follow‐up in Rochester, Minnesota, 1935–1984 , 1988, Cancer.

[5]  H Lumerman,et al.  Oral epithelial dysplasia and the development of invasive squamous cell carcinoma. , 1995, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[6]  E. Schwimmer.  Die idopathisches Schleimhaut-plaques der Mundhohle (leukoplakia buccalis) , 1877 .

[7]  P. Reichart,et al.  Oral erythroplakia--a review. , 2005, Oral oncology.

[8]  Joel B Epstein,et al.  Interobserver reliability in the histopathologic diagnosis of oral pre-malignant and malignant lesions. , 2004, Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology.

[9]  H. Mincer,et al.  Observations on the clinical characteristics of oral lesions showing histologic epithelial dysplasia. , 1972, Oral surgery, oral medicine, and oral pathology.

[10]  M. K Rollert,et al.  Oral white lesions with special reference to precancerous and tobacco-related lesions: Conclusions of an international symposium held in Uppsala, Sweden, May 18–21 1994 , 1996 .

[11]  J. Pindborg,et al.  [Surgical treatment of premalignant lesions of the oral mucosa]. , 1985, Tandlaegebladet.

[12]  C. Tsai,et al.  Clinical evaluation of different treatment methods for oral submucous fibrosis. A 10-year experience with 150 cases. , 1995, Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology.

[13]  W. Neville,et al.  Oral and Maxillofacial Pathology , 2004 .

[14]  J. Bánóczy,et al.  Occurrence of epithelial dysplasia in oral leukoplakia. Analysis and follow-up study of 12 cases. , 1976, Oral surgery, oral medicine, and oral pathology.

[15]  A. Mashberg,et al.  Early detection, diagnosis, and management of oral and oropharyngeal cancer , 1989, CA: a cancer journal for clinicians.

[16]  S. Warnakulasuriya.  Lack of molecular markers to predict malignant potential of oral precancer , 2000, The Journal of pathology.

[17]  R. Irani,et al.  Incidence rates of oral cancer and natural history of oral precancerous lesions in a 10-year follow-up study of Indian villagers. , 1980, Community dentistry and oral epidemiology.

[18]  C. Scully,et al.  Update on oral lichen planus: etiopathogenesis and management. , 1998, Critical reviews in oral biology and medicine : an official publication of the American Association of Oral Biologists.

[19]  Albert C. Broders,et al.  CARCINOMA IN SITU CONTRASTED WITH BENIGN PENETRATING EPITHELIUM , 1932 .

[20]  L M Abbey,et al.  Actinic cheilitis: a review of 152 cases. , 1999, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[21]  E. Eisenberg,et al.  Intraexaminer and interexaminer reliability in the diagnosis of oral epithelial dysplasia. , 1995, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[22]  J. Sudbø,et al.  Progress in determining the malignant potential of oral lesions. , 2003, Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology.

[23]  Hellquist,et al.  Criteria for grading in the Ljubljana classification of epithelial hyperplastic laryngeal lesions. A study by members of the Working Group on Epithelial Hyperplastic Laryngeal Lesions of the European Society of Pathology , 1999, Histopathology.

[24]  F. Mehta,et al.  A follow-up study of sixty-one oral dysplastic precancerous lesions in Indian villagers. , 1977, Oral surgery, oral medicine, and oral pathology.

[25]  P. Speight,et al.  Proliferative verrucous leukoplakia: a report of ten cases. , 1996, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[26]  L. Pickle,et al.  Snuff dipping and oral cancer among women in the southern United States. , 1981, The New England journal of medicine.

[27]  S. Petti.  Pooled estimate of world leukoplakia prevalence: a systematic review. , 2003, Oral oncology.

[28]  J. Bouquot,et al.  Oral leukoplakia--rationale for diagnosis and prognosis of its clinical subtypes or "phases". , 1994, Quintessence international.

[29]  M. Gorsky,et al.  Proliferative verrucous leukoplakia: a follow-up study of 54 cases. , 1997, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[30]  S. Silverman,et al.  Oral lichen planus update: clinical characteristics, treatment responses, and malignant transformation. , 1997, American journal of dentistry.

[31]  Paul M. Speight,et al.  The pathology of oral cancer and precancer , 1996 .

[32]  G. Bradley,et al.  Observer agreement in the grading of oral epithelial dysplasia. , 2003, Community dentistry and oral epidemiology.

[33]  J. Bouquot,et al.  Erythroplakia: the dangerous red mucosa. , 1995, Practical periodontics and aesthetic dentistry : PPAD.

[34]  N. Tanaka,et al.  A study of the clinical characteristics and treatment of oral carcinoma in situ. , 1985, Oral surgery, oral medicine, and oral pathology.

[35]  D. Gnepp,et al.  Epidemiology of carcinoma in situ of the upper. Aerodigestive tract , 1988, Cancer.

[36]  K. Schepman,et al.  A review of the recent literature regarding malignant transformation of oral lichen planus. , 1999, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[37]  R. Gorlin,et al.  Leukoplakia, lichen planus, and other oral keratoses in 23,616 white Americans over the age of 35 years. , 1986, Oral surgery, oral medicine, and oral pathology.