Abstract
Oral potentially malignant disorders (PMDs) are at risk of transforming to invasive squamous cell carcinoma (SCC), but controversy exists over their management and the precise role of interventional treatment. In this study, a cohort of 100 patients presenting with new, single oral dysplastic PMD lesions were followed for up to 10 years following laser excision. PMDs presented primarily as homogeneous leukoplakias on floor of mouth and ventrolateral tongue sites and showed mainly high-grade dysplasia following analysis of excision specimens. Sixty-two patients were disease-free at the time of the most recent followup, whilst 17 experienced same site PMD recurrence, 14 developed further PMDs at new sites, 5 underwent same site malignant transformation, and 2 developed SCC at new oral sites. Whilst laser excision is an effective therapeutic tool in PMD management, prolonged patient followup and active mucosal surveillance together with clear definitions of clinical outcomes are all essential prerequisites for successful interventional management. Multicentre, prospective, and randomised trials of PMD treatment intervention are urgently required to determine optimal management strategies.
Highlights
Oral potentially malignant disorder (PMD) is the preferred World Health Organisation (WHO) term to describe a number of mucosal lesions which demonstrate an increased risk of squamous cell carcinoma (SCC) development compared with apparently normal oral mucosa
One hundred lesions were formally excised by laser, the majority (76) appearing clinically as leukoplakias (67 homogeneous and 9 nonhomogeneous), and the remaining were classified as erythroleukoplakias (16) and erythroplakias (8)
Following consensus WHO grading of the excision specimens, 42 of the lesions were classified as mild dysplasia, whilst the remainder showed moderate dysplasia (26), severe dysplasia (21), or carcinoma in situ (11) (Kappa value = 0.644, P < 0.001)
Summary
Oral potentially malignant disorder (PMD) is the preferred WHO term to describe a number of mucosal lesions which demonstrate an increased risk of squamous cell carcinoma (SCC) development compared with apparently normal oral mucosa. Both the diagnostic accuracy of obtaining definitive histopathology specimens and the treatment efficacy of the entire lesion removal by interventional laser surgery, and it is generally accepted that PMD excision is probably the optimal management option [1,2,3]. It remains impossible, to predict either the behaviour of individual PMD lesions or the progress of disease in a particular patient, and some authors raise concerns that formal PMD excision is not proven to prevent SCC development, it remains a not unreasonable hypothesis [2, 3]. The aim of this paper, is to report on the detailed clinical outcome and followup of a cohort of 100 PMD patients who all underwent a standardised interventional laser surgery treatment to excise dysplastic single lesion disease and whose postoperative progress was documented for up to 10 years following the first presentation
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