Abstract
Simple SummaryOral potentially malignant disorders (OPMDs) include a group of oral mucosal diseases with different morphological characteristics that are able to progress to oral squamous cell carcinoma (OSCC). Given OSCC’s poor prognosis and high mortality, early diagnosis is a priority step in OSCC. Extrinsic and intrinsic risk factors and etiologies are involved in developing and malignant transformation of oral lesions, and different molecular alterations have been described in early lesions associated with a potential malignant behavior. This review summarizes the information about clinical, morphological and molecular features of OPMDs, with an emphasis on the early detection techniques and an overview of the surgical and systemic therapies’ effectiveness.Oral squamous cell carcinoma (OSCC) is a very aggressive cancer, representing one of the most common malignancies worldwide. Oral potentially malignant disorders (OPMDs) regroup a variegate set of different histological lesions, characterized by the potential capacity to transform in OSCC. Most of the risk factors associated with OSCC are present also in OPMDs’ development; however, the molecular mechanisms and steps of malignant transformation are still unknown. Treatment of OSCC, including surgery, systemic therapy and radiotherapy (alone or in combination), has suffered a dramatic change in last years, especially with the introduction of immunotherapy. However, most cases are diagnosed during the advanced stage of the disease, decreasing drastically the survival rate of the patients. Hence, early diagnosis of premalignant conditions (OPMDs) is a priority in oral cancer, as well as a massive education about risk factors, the understanding of mechanisms involved in malignant progression and the development of specific and more efficient therapies. The aim of this article is to review epidemiological, clinical, morphological and molecular features of OPMDs, with the purpose to lay the foundation for an exhaustive comprehension of these lesions and their ability of malignant transformation and for the development of more effective and personalized treatments.
Highlights
Oral potentially malignant disorders (OPMDs) are defined as a group of oral mucosal lesions with an increased risk of malignant transformation. These disorders include a mixture of diseases with different clinical appearance, histological subtypes and risk factors/etiologies and comprise various entities, such as leukoplakia, erythroplakia, erythroleukoplakia, oral lichen planus, oral submucous fibrosis (OSF) and oral dysplasia [1,2]
While OPMD is ascribed to clinical presentations, oral epithelial dysplasia (OED) is histo-morphologically defined as a spectrum of epithelial changes associated with an increased risk of transformation to carcinoma
Results from this study confirmed the role of Loss of heterozygosity (LOH) as a negative prognostic factors for malignant transformation with a 3-year cancerfree survival of 74% for LOH-positive patients, compared with 87% for LOH-negative patients (HR 2,19; 95% CI 1.25–3.83; p = 0.01); increased epidermal growth factor (EGFR) copy number was associated with LOH profiles
Summary
Oral potentially malignant disorders (OPMDs) are defined as a group of oral mucosal lesions with an increased risk of malignant transformation. Early detection, diagnosis and treatment of premalignant lesions is mandatory to prevent their transformation to OSCC and to increasing the 5-year survival rate [4]. Different risk factors have been associated to these lesions, most of them shared with OSCC, but the mechanisms and the causes of malignant transformations remain unclear. Lifestyle factors, such as use of tobacco, consumption of alcohol, derivatives of betel nut and sexually transmitted infection of human papilloma virus (HPV, mainly type 16) represent the main causes associated with OPMDs and oral cancer. Though HPV oncogenic types have a higher prevalence in OPMDs than in the healthy oral mucosa, there is insufficient evidence of the malignant potential of the virus in premalignant lesions
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