Dysplasia of the oral cavity

Dysplasia

As with other mucosal sites, when present, dysplasia is graded as mild, medium, severe / severe and in situ carcinoma. The diagnostic histological criteria used are superimposable to those formulated to describe the steps of the tumor progression of other districts: they indicate the extent of the architectural alteration of the mucosa and of the cytological atypia. Morphological changes that may extend from the epithelium of mucosal lining to the ducts of the minor salivary glands. In a minority of cases, with dysplastic abnormalities of the epithelium, they may be preceded or coexist with hyperkeratosis, hypergranulosis and irregularity of the basal layer, a condition that is defined as lichenoid dysplasia. Currently the term intraepithelial oral neoplasia (OIN) is used for the complex premalignant lesions, which is graded as:
• grade I, lesion corresponding to mild dysplasia;
• grade II, corresponding to the average dysplasia;
• grade III, which corresponds to severe in situ carcinoma dysplasia.

The term is also used, more generic, and not advisable, of keratosis followed by qualifying terms (such as lichenoid, verrucous, proliferative, verrucous), also specifying the degree of epithelial dysplasia which may be: mild;

severe dysplasia, in situ carcinoma, atypical epithelial cells that do not cross the basal membrane

Mucosa genena with lichen planus, arrows

average; severe or severe; or having the characters of the carcinoma in situ -CIS-.In fact, recent studies have shown significant differences in practical relevance between keratosis with dysplasia and keratosis without dysplasia: so the name of the extent of the lesion (degree of dysplasia) should precede that of the epithelial lesion (of the type of keratosis), possibly indicating, and if possible in objective and quantified terms, also the expression of growth factors such as EGFR, indicators of the extent of proliferative activity (Mib-1 expression, etc.), also signaling the intraepithelial level of positivity that can be: basal, parabasal, intermediate and diffused in all the compartments / layers. In the past oral pre-cancers were studied by examining bioptic samples performed at random, being the following therapeutic protocol based on partial and incomplete histological data that, if negative, the lesion was followed by six-monthly clinical checks and, if positive, proceeded to surgical removal. The current orientation, based on the excisional biopsy of the lesion and on the serious and complete histological microscopic examination of the same, allows a diagnostic definition much more precise and also the formulation of the prognosis and a therapeutic program adequate to the real pathology (dysplasia, ca. in situ, ca. initial infiltrant, infiltrating and diffused ca. Diagnostic-therapeutic conduct that allows, with a single operating session, to formulate the diagnosis and prognosis of the actual lesion and, at the same time, to apply the "appropriate therapy according to the" follow up ", summarized below:
- dysplasia: semestral clinical checks of the oral mucosa;
- in situ carcinoma with surgical margins of the tissue free of neoplastic infiltration: bi-monthly clinical checks for the first six months, quarterly for the following semester and then half-yearly;
- in situ carcinoma with initial infiltration: radical surgery;
- infiltrating squamous cell carcinoma: therapy according to the protocols established at international level.

Lichen planus

injury considered precancerous, to be monitored but not a cancer of the mouth.

Introduction
Lichen planus is an inflammatory disease that can affect the skin and mucous membranes, which usually occurs in the form of flat and reddish pustules that in many cases cause itching. It appears mainly on: limbs (arms and legs), trunk, mouth, nails, scalp, genital organs (vulva, vagina and penis). On the mucous membranes, for example inside the mouth or vagina, the lichen planus appears in the form of reticular or whitish lesions or pustules, which can cause discomfort. Lichen planus is not contagious (not even sexually) and manifests itself when the immune system triggers an attack on the skin or mucous membranes: the cause of this abnormal immune reaction is not known with certainty, but there does not seem to be any familiarity.

Leukoplakia

It is a "white" lesion that, in the form of a white patch or plaque, forms on the oral mucosa, having clinical and histological features that do not correspond to any of the known mucosal lesions. (WHO 1978).

Anatomo-clinical staging of leukoplakias has been proposed in which both clinical and histological parameters are taken into consideration with particular reference to epithelial dysplasia. From this point of view, the observed lesion must be classified among the precancerous conditions only when the histological examination shows the presence of epithelial dysplasia.
Epidemiology and risk factors for leukoplakia
The incidence of leukoplakia, considered one of the most common white lesions of the oral cavity, affects around 2-4% in the adult population, with a particular predilection for the male sex, even if in some countries (India and Pakistan) this lesion affects with greater frequency of female sex, a condition associated with increased smoking. The maximum incidence is observed in the 5th decade. Among the various risk factors should be considered those responsible for oral carcinoma and in particular the use of tobacco, alcohol abuse and repeated trauma. A percentage of cases fall within the group of essential leukoplakias, with no clear relationship with the factors described. Other factors are industrial processing with arsenic poisoning and heavy metals, textile workers; Infectious factors (HIV, HBV, HPV). Traumatic factors, for example, related to the use of dental prostheses, mobile bridges, protein and vitamin deficiencies.

Clinico-pathological feature of leukoplakia.

It is a lesion that affects, in decreasing order, the buccal mucosa, the oral floor, the labial retrocissure, the tongue, the gingival mucosa, the retromolar tract and the palatal mucosa. In almost all cases it is the mother-of-pearl white color that characterizes the lesion that depends precisely on hyperkeratosis and acanthosis of the epithelium, events that end up modifying the rosy color of the underlying corion, which has a rich vascular network. . There are mixed forms of lesions in which the white complexion alternates with red areas (leuco-erythroplakia). The main clinical forms of leukoplakia are: the homogeneous flat variant, the verrucous variant and the non-homogeneous fixed variant.

Erythroplakia

It is a "red" lesion that can not be correlated, either clinically or histologically, to another well-defined lesion. The most typical sites consist of: soft palate, venial surface of the tongue, and oral floor, although all oral sites may be involved. Erythroplasty lesions show a high risk of progresion towards squamous cell carcinoma.
tumors index