Soft palatal melanosis as a predictor for neoplasia in the upper aerodigestive tract.

Abstract

1542 Background: Squamous cell dysplasia and carcinoma in the upper aerodigestive tract (UAT) was frequently accompanied by melanosis in the UAT. Soft palatal melanosis can be detected by visual inspection during routine physical examination or even personally in a mirror. Methods: We reviewed digitalized records of high-quality endoscopic images of the soft palate of 1786 Japanese alcoholic men who underwent endoscopic screening combined with esophageal iodine staining and evaluated to what extent the presence of soft palatal melanosis combined with other risk factors can predict the risk of UAT neoplasia. Results: Soft palatal melanosis was observed in 381 (21·3%) of the subjects (mild, 15·0%; distinct, 6·3%). An older age, an inactive heterozygous aldehyde dehydrogenase-2 genotype, smoking, and a high mean corpuscular volume (MCV) were positively associated with the presence of soft palatal melanosis. The age-adjusted odds ratio (OR [95% CI]) for neoplasia in the UAT was 1·92 [1·40–2·64] in the group with melanosis and 2·51 (1·55–4·06) in the group with distinct melanosis, compared with the melanosis-free group. A multiple logistic analysis including the alcohol and aldehyde dehydrogenases genotypes and non-genetic risk factors showed that the presence of soft palatal melanosis was independently associated with a high risk of neoplasia in the UAT. We calculated the individual number of risk factors out of four easily identifiable and significant factors: age ≥55 years, current/former alcohol flushing, MCV ≥106 fl, and distinct soft palatal melanosis. Compared with the risk-factor-free condition, the OR (95% CI) values of UAT neoplasia for one, two, three and four risk factors were 1·49 (0·97–2·30), 3·14 (2·02–4·88), 4·80 (2·71–8·51) and 7·80 (2·17–28·1), respectively. Conclusions: Soft palatal melanosis combined with other simple risk assessments provides a simple new strategy for identifying heavy drinkers with a high risk for UAT neoplasia.