Oral potentially malignant disorders

Abstract

At a World Health Organization workshop held in 2005, the term “oral potentially malignant disorders” (OPMDs) was recommended instead of “premalignant lesions and conditions.” This chapter describes two OPMDs, namely, oral leukoplakia and erythroplakia. Oral leukoplakia is a newly defined entity of white plaques of questionable risk after excluding (other) known diseases or disorders carrying no increased risk for cancer. The clinical findings of patients with leukoplakia may depend on the oral habits of tobacco chewing and smoking. The risk factors for the development of oral squamous cell carcinoma (OSCC) in patients with leukoplakia are female sex, age >50 years, large lesions, tongue or floor of mouth, the buccal mucosa in association with tobacco habits, non-homogeneous and epithelial dysplasia. Surgery has been recommended for leukoplakia by some researchers, though some reviewers have voiced their concerns over a lack of evidence for surgery. The author proposes that oral leukoplakia should be surgically removed with sufficient margin using iodine staining and that patients having leukoplakias with or without epithelial dysplasia should be followed up at regular intervals with or without surgery in order to detect recurrent or new lesions in the initial stage. Erythroplakia is a rare OPMD in which the soft palate, floor of mouth, and buccal mucosa are commonly affected, but the tongue and any other site of the oral cavity can also be affected. As erythroplakia has the highest malignant potential of the OPMDs, surgery is recommended for its treatment, and regular follow-up is important for decreasing the development of OSCC from erythroplakia.