1. Pre-malignant lesions of Oral cavity
Dr.SHANKHASHUBHRA GHOSH
DLO,2ND YR
Stanley Medical College
Chennai

3. Benign lesions Solid- papilloma fibroma hemangioma granuloma
torus palatinus
Cystic - retention cyst
ranula
dermoid

4. Premalignant lesions Leukoplakia Erythroplakia Submucous fibrosis
Lichen planus
Laryngeal keratosis
Actinic cheliosis
Smooth,red tongue of Plummer-Vinson syndrome

5. Predisposing factors EIGHT -- “S” Smoking syphilis spices sharp tooth
submucosal fibrosis
siderophenic dysphagia
sepsis
spirit(alcohol)

6. Leukoplakia -etiology
Tobacco chewing and smoking
Alcohol
Local irritants
Vitamin deficiency-vit A & B
Endocrine disturbances
Syphilis

7. leukoplakia

8. leukoplakia
White patch in mucosa that does not rub off & cannot be clinically identified
Most are asymptomatic,only 20% show evidence of dysplasia or carcinoma.
Buccal mucosa and oral commissures are most common sites
Mostly fourth decade, male>female

9. Non –homogenous leukoplakia

10. Management Proper history Prevention of cause
Surgical excision of small lesion
Topical chemotherapy and radiation

11. Erythroplakia Red lesion that cannot be classified as another entity.
91% shows signs of dysplasia
Flat, macular, velvety appearance and may be speckled with white spots representing foci of keratosis
Most common site-lower alveolar mucosa, gingivobuccal sulcus

13. Types:- A)Homogenous type:
appears as bright red soft velvety lesions and extensive in size.
commonly found-buccal mucosa and soft palate.
B)Speckled type:
soft red lesions,slightly elevated with irregular outline
surface being granular-speckled

14. Submucous fibrosis
Subepithelial inflammatory response to the irritants mainly due to betel nut chewing
Arecoline-active alkaloid found in betel nuts-stimulate fibroblasts to increase production of collagen by 150%
White fibrotic bands extending from retromolar trigone to soft palate,buccal mucosa , tongue.
It continues even after cessation of areca nut chewing

18. Clinical features
The most common initial symptom-burning sensation of oral mucosa aggravated by spicy food followed by either hypersalivation or dryness of mouth
In advanced cases,the mucosa becomes tough and leathery, with numerous vertical fibrous band.

19. Clinical staging
Stage1-stomatitis..vesicles,mucosal ulcers, mucosal petechie
Stage2-fibrosis in ruptured vesicles and ulcers. a)early-blanching..
b)late-vertical and circular palpable fibrous bands, trismus, blanched leathery floor of mouth, fibrotic and depigmented gingiva.
Stage3-leukoplakia(>25%) and speech & hearing deficits.

20. Treatment Prescription of chewable pellets of hydrocortisone
Absteinence from alcohol,tea,coffee
Submucosal inj of hydrocortisone
Submucosal inj of human chorionic gonadotropin
Surgical treatment-multiple release deep to mucosa,submucosa and fibrotic tissue & suturing the gap so created by mucosal flap obtained by tongue and Z-plasty.

21. Cont…..
In this procedure,multiple deep z shaped incisions are made into fibrotic tissue and sutured in straight fashion
Pentoxifylline-vasodilating properties and increased mucosal vascularity used as adjunct therapy.
Stem cell therapy-intralesional inj of autologus bone marrow stem cell –angiogenesis of area and decreases fibrosis.

22. Lichen planus Malignant potential is matter of dispute
Prudent practice to biopsy the lesion at first visit to confirm diagnosis or monitor changes.
Lesion appear white lace like pattern in buccal mucosa.

24. Relative risk factors for oral cancer
None %
Bettle nut Chewing %
Smoking only %
Bettel chewing+Tobacco chewing 15%
Bettel chewing+Smoking %
Bettel+Tobacco+smoking %

25. Treatment If carcinoma-in-situ proved—excision by CO2 or KTP532 laser
Chemoprevention-beta-carotene and retinoids as antioxidant supplements

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