you see a patient and you notice an abnormality and the question that you
have in your mind to biopsy or not.That is the question. On the top left you have
classic snuff dippers leukoplakia and the middle top you have a mixed
leukoplakia Caruth or plate on the top right you have a nonspecific ulcer on
the bottom right you have erythema with a river flaky totally asymptomatic on
the fall and the bottom middle you'd have leukoplakia which is rather
diffuse and asymptomatic and then the last bottom left you have thickened
leukoplakia anterior flora mouth which crosses the midline and also involves
the freedom to biopsy or not? That is the question what is a pre malignant
lesion leukoplakia and Northrup lakeya are considered precancerous lesions
actinic keratosis oral submucosal fibrosis and lichen planus
technically are designated as precancerous lesions there are no known
precursor lesions for a HPV associated oropharyngeal carcinoma leukoplakia
accounts for 85% of all oral pre malignant lesions and most frequently
occur at a single site erythroplakia is less common but nearly 100
percent will exhibit either dysplasia carcinoma in situ or invasive squamous
cell carcinoma there are diagnostic aids that we have available to us to assist
in the detection of oral cancer going from brush biopsy to vital staining
light based detection systems and fluorescence in oral and ecology in 2007
basically the statement was the public awareness of oral cancer is high and are
a lot of marketing device attempts out there to have a magic wand but pre
cancers and cancers are not showing improved detection beyond conventional
oral examination alone the adjuncts have yet to be rigorously
confirmed as a substitute for a thorough examination leukoplakia goes from very
stages from normally cosa to thin smooth leukoplakia to thick fisher leukoplakia
to granular and then a erythroplakia leukoplakia mixed you see the
transition on this slide every one of these lesions should be biopsied under
microscopy the pathologist is either going to say we have the patient has
epithelial hyperkeratosis epithelial hyperplasia with or without dysplasia
carcinoma in situ or invasive squamous cell carcinoma the created current
grading system of oral epithelial dysplasia using the terms mild moderate
severe is not very useful due to variable interpretation and only three
to five percent of these progressed to a higher degree of dysplasia newest
literature states ten to twenty percent recurrence rate of excised lesions and
three to nine percent malignant transformation at the excise site with a
significant higher incidence when a laser is used we to this date do not
know why this is the newest information oral squamous cell carcinoma is a
disease of genetic deregulation the basal cell stratum basale are the
critical cells because they are the only ones with proliferative capacity the
pik3ca gene for squamous cell and the fgfr3 gene for HPV have recently been
identified and their suppression with chemo preventive agents is currently
being studied also using mutated proteins called neo antigens that are
being transported by messenger RNA specific to an individual's tumor will
be an individual treatment but a universal process also being researched
are the use of immune modeling modulators wouldn't it be great if
patients don't have to suffer through chemotherapy and/or radiation
Lichen Planus is a chronic skin disease that involves the oral mucosa
often first and it was described initially in 1869 newest evidence
indicates that that's immunological II mediated disorder primarily affecting
the basal and pair of basal epithelial cells there are two main forms reticular
and erosive and the original description of lichen planus presented in 1961 i
stood the test of time i bring this to your attention because there's also a
category called like annoyed drug reaction there are a growing number of
patients who present clinically with white reticular lesions but do not
have lichen planus and histopathologicaly they're indistinguishable from lichen planus
or what's the cause well we have a patient population that is on a
polypharmacy of drugs from antihypertensive to Anzio lytx the
NSAIDs oral hypoglycemics Yuriko suruc agents dental materials can cause a leg
annoyed drug reaction certain foods and oral hygiene products can cause that so
what do we do in this instance it's imperative upon the dentist to work with
the prescribing physician nurse practitioners and physicians assistants
as well as the pharmacist to see if they can come up with modifications to
mitigate the like annoyed drug reactions the standard of care at this point in
time if they're erosive or symptomatic is the use of light x ointment
fluocininide 0.05 percent it's a steroid it's for topical use only and it does
not cure the lesion it helps reduce the symptoms head neck cancer is the six
most common more than 90% are squamous cell and arise from the mucosal surfaces
of the oral cavity oral pharynx and larynx the habits of tobacco and alcohol
contribute to 80% of all squamous cell globally
hpv-associated squamous cell involves the posterior third of the
tongue tonsils and lateral pharyngeal walls HPV 16, 18, 31 and 32 are the most
common greater than 90% are 16 which also is the same for cervical cancer
31st to 60% have positive lymph nodes at the time of diagnosis and currently the
three-year survival is 82% if someone also smokes it's 57 percent so to biopsy
or not? That is the question at least give the patient the best chance I
recommend a biopsy