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PREMALIGNANT LESIONSPREMALIGNANT LESIONS ARE GROUP OF GROUP OF CONDITIONS WHICH PREDISPOSE TO THE SUBSEQUENT DEVELOPMENT OF CANCER. THESE CONDITIONS ARE IMPORTANT TO RECOGNIZE AS TO PREVENT THE SUBSEQUENT DEVELOPMENT OF AN INVASIVE CANCER CONDITIONS CHARACTERIZED BY MORPHOLOGIC CHANGES IN THE CELLS SUCH AS :- INCREASED NUCLEAR CYTOPLASMIC RATIO, PLEOMORPHISM OF CELLS AND NUCLEI , INCREASED MITOTIC ACTIVITY , POOR DIFFERENTIATION AND SOMETIMES ACCOMPANIED BY CHRONIC INFLAMMATORY CELLS LEUKOPLAKIA LEUKOPLAKIA :- IT IS A WHITE PATCH (OR) PLAQUE ON THE ORAL MUCOSA EXCEEDING 5 MM IN DIAMETER , WHICH CNANOT BE RUBBED OFF NOR CAN BE CLASSIFIED INTO ANY OTHER DIAGNOSABLE DISEASE. - LEUKOPLAKIA IS A PREMALIGNANT LESION OF THE ORAL CAVITY .
- IT OCCURS MORE FREQUENTLY IN MALES THAN FEMALES.
- LESIONS MAY BE OF VARIABLE SIZE AND APPEARANCE
- IN 4-6% CASES CARCINOMATOUS CHANGES REPORTED - IT IS DIFFICULT TO DECIDE WHICH LESION MAY TRANSFORM IN TO MALIGNANCY BUT LESION WITH SPECKLED (OR) NODULAR FORM PROGRESSES TO MALIGNANCY
- SITES OF PREDILECTION IN DESCENDING ORDER OR FREQUENCY ARE :-
- CHEEK MUCOSA .
- ANGLE OF MOUTH .
- ALVEOLAR MUCOSA .
- TONGUE .
- LIP.
- HARD AND SOFT PALATE .
- FLOOR OF THE MOUTH .
ETIOLOGY - SIMILAR TO CARCINOMA OF THE ORAL MUCOSA .
- IT HAS THE STRONGEST ASSOCIATION WITH THE USE OF TABACCO IN VARIES FORMS eg:- IN HEAVY SMOKERS - ESPECIALLY IN PIPE & CIGAR SMOKERS . IMPROVES WHEN SMOKING IS DISCONTINUED .
- WHO CHEW TABACCO AS IN PAAN , PAAN MASALA , ZARDA , GUTKA ETC .
- CONDITION ALSO KNOWN AS :- SMOKERS KERATOSIS AND STOMATITIS NICOTINA .
- OTHER ETIOLOGICAL FEATURES ARE :- CHRONIC FRICTION SUCH AS ILL FITTING DENTURES (OR) JAGGED TEETH
- LOCAL IRRITANTS LIKE EXCESSIVE CONSUMPTION OF ALCOHOL AND VERY HOT AND SPICY FOODS AND BEVERAGES
PATHOLOGY GROSS APPEARANCE :- - LESIONS APPEARS WHITE , WHITE - YELLOW OR RED VELVETY OF MORE THAN 5 MM DIAMETER AND VARIABLE APPEARANCE .
- USUALLY THEY ARE CIRCUMSCRIBED , SLIGHTLY ELEVATED , SMOOTH OR WRINKLED , SPECKLED OR NODULAR .
MICROSCOPIC EXAMINATION :- - HYPERKERATOTIC TYPE :-
- CHARACTERIZED BY AN ORDERLY AND REGULAR HYPERPLASIA OF SQUAMOUS EPITHELIUM WITH HYPERKERATOTIC ON THE SURFACE .
2. DYSPLASTIC TYPE :- - ITS SHOWS REGULAR STRATIFICATION OF THE EPITHELIUM , FOCAL AREAS OF INCREASED AND ABNORMAL MITOTIC FIGURES , HYPERCHROMATISM , PLEOMORPHISM LOSS OF POLARITY AND INDIVIDUAL CELLS KERATINIZATION.
- SUBEPITHELIAL TISSUE SHOWS AN INFLAMMATORY INFILTRATE OF LYMPHOCYTES AND PLASMA CELLS
- EXTENT AND DEGREE OF EPITHELIAL CHANGE INDICATED DEGREE OF SEVERITY CONSIDERED AS EPITHELIAL DYSPLASIA.
- MILD DYSPLASIA REVERTS BACK TO NORMAL ONCE THE OFFENDING ETIOLOGICAL FACTOR IS REMOVED . WHERE AS SEVERE DYSPLSIA INDICATES THE PROGRESSION OF CARCINOMA.
- ERYTHROPLASIA IS A FORM OF DYSPLASTIC LEUKOPLAKIA WHERE EPITHELIAL ATYPIA IS MARKED AND HAS HIGHER RISK OF DEVELOPING INTO MALIGNANCY .
- IF THE EPITHELIAL DYSPLASIA IS EXTENSIVE SO AS TO INVOLVE THE ENTIRE THICKNESS OF THE EPITHELIUM , THE LESION IS CALLED CARCINOMA IN SITU WHICH PROGRESS TO INVASIVE CARCINOMA .
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