Early Invasive Squamous Cell Carcinoma Research Articles

Comparative evaluations of different surgical and non-surgical treatment methods for early invasive and micro invasive squamous cell carcinoma in the oral and maxillofacial regions: A systematic review

Objectives: The pathogenesis and progressive behavior of head, neck, oral and maxillofacial (HNOMF) squamous cell carcinoma (SCC) has been suggested to be a multistep and multifactorial procedure that necessitates epithelial hyperplasia, epithelial dysplasia, micro invasive squamous cell carcinoma (MISCC) and early invasive squamous cell carcinoma (EISCC); EISCC and MISCC might have a completely different behavior and development process. There are only a limited number of reported HNOMF cases of EISCC or MISCC. There are still no guidelines for the treatment of EISCC and MISCC lesions in the HNOMF regions. Material and Methods: This systematic review was conducted to gather all surgical and non-surgical treatments for EISCC and MISCC lesions in the HNOMF. The study question according to the PICO format was as followed: clinical and histopathological results (O) of all types of treatments (I) for patients with EISCC and MISCC lesions in HNOMF (P) compared to untreated lesions (C). Medline, Scopus, and Google Scholar were searched and the search was limited to English-language. Results: Eight clinical human studies were included. Photodynamic therapy (PDT) after topical application of methyl aminolevulinate (MAL-PDT) and topical Imiquimod 5 % cream both had remarkable outcomes. Conclusions: However, due to the very limited number of studies conducted on the treatment methods of MISCC and EISCC in the HNOMF regions, further studies are necessary to provide reliability for non-surgical treatment methods.

Comparative analysis of oral epithelial malignancies using routine stain and modified Cajal’s trichrome stain: An histopathological study

Diagnosis of initial epithelial pathology maybe difficult in Oral Squamous Cell Carcinoma (OSCC), early invasive squamous cell carcinoma and other atypical epithelial malignancies, under routine Haematoxylin and Eosin (H and E) stain. In this context, an appropriate differential stain capable of distinguishing epithelial cells in the connective tissue may well prove to be a valuable aid. In the present study, we endeavor to use Modified Cajal's trichrome stain for making diagnosis easier without resorting to expensive diagnostic aids. Aim of present study is to assess both the epithelial and connective tissue elements in early invasive carcinoma, verrucous carcinoma and oral squamous cell carcinoma in tissue sections stained with modified Cajal's trichrome stain (MCTS) and to compare it with H and E-stained sections. Formalin-fixed, paraffin-embedded tissue blocks of early invasive SCC (n = 10) Verrucous carcinoma (n = 10) OSCC (n = 10) were stained with MCTS and H&E. The sections were compared based on set histopathological criteria. In SCC cases stained with MCTS, invasion into connective tissue and keratin pearls were strikingly evident. Depth of invasion could be more accurately determined. Thus, CTS is a good differential stain, clearly delineating the epithelial elements from the connective tissue elements visually.

A study of stromal collagen in oral lichen planus, carcinoma in situ, early invasive squamous cell carcinoma, and normal mucosa using picrosirius red stain

Background and Objectives: Oral lichen planus (OLP) is a chronic disease of uncertain cause commonly affecting oral cavity. Although the WHO has designated OLP as a “potentially malignant disorder,” controversies exist regarding its malignant potential. Collagen forms the principal component of stroma or extracellular matrix and its role in carcinogenesis is widely studied in other premalignancies. Although collagen at the basal complex of OLP is widely explored, studies on collagen in the connective tissue stroma are not reported to date. We aimed to observe the nature of collagen in connective tissue stroma of OLP using picrosirius red stain (PSR) under polarized microscope and compare with buccal mucosa without any pathology related to exposure to tobacco and other oral carcinogens, carcinoma in situ (Ca in situ), and early invasive squamous cell carcinoma (EISCC). Materials and Methods: Eighty samples were observed, with twenty samples in each study group. Two 4–6-μ thick sections were obtained from the archival blocks. One section was stained with hematoxylin and eosin for confirming the diagnosis, whereas PSR staining was done for the other section. Both sections were analyzed using a polarizing microscope for evaluating the polarization colors of collagen. The images captured were stored on a computer. Five nonoverlapping fields were selected from each section in all groups and the thickness of five collagen fibers from each section was measured in microns using image analysis software and the polarizing color was also noted. The values obtained were compared using Kruskal–Wallis H-test and Chi-square test. We also used Mann–Whitney U-test for intergroup comparison. Results: The mean width of thick as well as thin fibers was more in controls than Ca in situ, OLP, and EISCC in decreasing order. Mature fibers were predominant in the controls than Ca in situ, OLP, and EISCC in decreasing order. Immature fibers were predominant in EISCC, followed by OLP, Ca in situ, and controls. Comparison of collagen in OLP and Ca in situ showed no statistically significant result in terms of thickness and polarization colors confirming a similarity in the nature of collagen in these two lesions. Conclusion: The stromal collagen of OLP was comparable to Ca in situ suggesting a change in the structure and organization of collagen probably attributed to the role of inflammatory mediators. A study with bigger sample size is recommended to evaluate the role of collagen in malignant transformation of OLP.

Trial in progress: Phase II activity trial of high-dose radiation and chemosensitization in patients with macrometastatic lymph node spread after sentinel node biopsy in vulvar cancer: Groningen International Study on Sentinel Nodes in Vulvar Cancer III (GROINSS-V III/NRG-GY024).

TPS5624 Background: Early stage invasive squamous cell carcinoma of the vulva is treated by radical excision of the primary tumor combined with a sentinel node (SN) procedure for the groins. GROINSS-VI and GOG-173 demonstrated that if there is no metastasis to the SN, then standard of care is observation. GROINSS-VII/GOG-270 demonstrated that micrometastatic disease (<2mm) to the SN requires standard radiotherapy (50 Gy) without the need for an inguinofemoral lymphadenectomy (IFL). This study also found that patients with macrometastasis ( > 2mm) required IFL in order to have an acceptably low groin recurrence rate. However, IFL is associated with significant morbidity such as lymphedema, wound healing issues, and recurrent infections. It is hypothesized that for those with macrometastasis ( > 2 mm) in the SN, the efficacy of treatment can be increased by giving a higher dose of radiotherapy along with chemosensitization. Methods: This is an international multicenter single-arm phase II prospective clinical trial. The primary objective is to investigate the safety of replacing IFL by chemoradiation in early-stage vulvar cancer patients with a macrometastasis ( > 2mm) and/or extracapsular extension in the SN. The primary endpoint is the groin recurrence rate in the first two years after primary treatment. Secondary endpoints are short and long-term morbidity associated with the SN procedure and chemoradiation and quality of life as measured by EORTC-QLQc30. Patients with invasive ( > 1mm) squamous cell carcinoma of the vulva, stage T1, tumor size < 4 cm diameter and no suspicious lymph nodes by imaging of the groins will proceed with SN detection. Institutions enrolling patients must demonstrate prior surgical experience with SN detection with the submission of at least 10 successfully completed cases in vulvar cancer. Patients with SN metastases > 2mm and/or with extracapsular extension or those with > 1 SN with micrometastases will be eligible for this study. Treatment will consist of chemoradiation with a dose of 56 Gy to the groin combined with weekly cisplatin 40 mg/m2 IV on days 1, 8, 15, 21 and 29 of radiotherapy. One hundred and fifty-seven patients in Europe, United States and Canada will be enrolled. The study includes continuous monitoring of groin recurrences with stopping rules. Results of this trial may be practice changing and eliminate the need for IFL in all women with clinically early stage vulvar cancer. The study is currently open for enrollment. Clinical trial information: NCT05076942.

A Case of Facial Discoid Lupus Erythematosus (LE) with Oral Lichen Planus (LP): A Dig into Co-existence and LE-LP Overlap

A distinction between ‘co-existence of Lupus Erythematosus (LE) and Lichen Planus (LP)’ and ‘LE-LP overlap’ bears importance as the criterion for true overlap necessitates histological and immunological features of both LE and LP to be found in the same tissue specimen. However, in the present case report the lesions of LE and LP were present in two different sites. A 51-year-old male presented with a large erythematous scaly atrophic plaque on the right cheek with similar lesions on chin and lips for 10 years. He also had violaceous lesions on the bilateral buccal mucosa and a white lesion over the left buccal mucosa for three years. Discoid Lupus Erythematosus (DLE) and Oral Lichen Planus (OLP) were suspected. Dermoscopy of the facial plaque showed features consistent with DLE. Histopathology of the facial plaque confirmed the diagnosis of DLE, whereas the white plaque on the left buccal mucosa showed features of early invasive squamous cell carcinoma. Violaceous lesion over the right buccal mucosa showed features suggesting OLP. A Direct Immunofluorescence (DI) was also performed for the buccal mucosa to rule out the possibility of DLE with oral involvement, which turned out to be negative. Therefore, a diagnosis of synchronous presentation of DLE and OLP along with Squamous Cell Carcinoma (SCC) of the buccal mucosa was made and patient was treated with topical corticosteroids, systemic hydroxychloroquine and surgical intervention for the squamous cell carcinoma. It is also imperative that not only long standing cutaneous lesions, but also oral lesions like LP should be investigated and kept under observation to look for any early malignant changes.

Morphology of cells undergoing epithelial mesenchymal transition in microinvasive and early invasive oral squamous cell carcinom a – a light microscopic study

The present study focuses on identification of cancer attributes of epithelial mesenchymal transition (EMT) at the earliest possible stage (microinvasion) under alight microscope by using hematoxylin and eosin stains, making it feasible for researchers to investigate such cases with ease without the use of extensive setups. The present study is the first in the English literature to define EMT features in micro-invasive and early invasive oral squamous cell carcinoma (OSCC) under alight microscope. This is aretrospective study of histological sections of 43 cases of OSCC from the Department of Oral Pathology and Microbiology. The data collected were later statistically analyzed. Atotal of 11 micro-invasive and 32 early invasive OSCC cases were assessed for core features of EMT. The predominant feature defining EMT found was dense inflammatory infiltrate in both microinvasive (91%) and early invasive OSCC (88%) followed by cell individualization in 82% of microinvasive and 75% of early invasive OSCC, which was then followed by other features. Reporting EMT in histopathological reports on adaily basis can aid in early diagnosis of OSCC as well as understanding carcinogenesis in early stages. Thereby, inclusion of EMT targeting therapeutics in early stages of OSCC can significantly alter the prognosis of cancer.

Immunoexpression of C4 Binding Protein in Oral Leukoplakia and Oral Squamous Cell Carcinoma.

The immune evasion of dysplastic cells plays an important role in suppressing the immune response and progression of malignancy. The role of the complement inhibitors in the development of oral epithelial dysplastic lesions and squamous cell carcinoma (SCC) is still unclear. This study aimed to assess the expression of C4 binding protein (C4BP) as a complement inhibitor in oral squamous cell carcinoma and leukoplakia. In this study, 94 samples were classified into four groups: leukoplakia with mild to moderate dysplasia, leukoplakia with severe dysplasia or carcinoma in situ, early invasive SCC, and invasive SCC. The expression of C4BP marker was evaluated by immunohistochemistry (IHC) and real-time PCR. The results were analyzed by the Kruskal-Wallis, Bonferroni adjusted Dunn's multiple comparison, and one-way ANOVA tests. The results of IHC revealed the expression patterns of C4BP in oral dysplasia and SCC, and indicated that the C4BP expression was not significantly different between different histopathological grades in epithelial cells and vessels (P=0.157 and P=0.123, respectively) but, it was significantly different in fibroblasts and lymphocytes (P=0.017 and P=0.043, respectively). The real-time PCR showed a significant correlation between the dysplasia grade and expression of C4BP (P<0.05). According to the results, C4BP is expressed in the cancerous tissue by the tumor cells and their surrounding stroma. In addition, upregulation of the C4BP gene as an inhibitor of the complement system is a possible strategy adopted by the tumor cells to evade the immune system.

Pure primary ovarian carcinoid tumor with carcinoid syndrome and cervical carcinoma: A rare concoction of dual primary malignancies

Carcinoid tumors are defined as rare slow-growing neuroendocrine tumors. A majority of primary ovarian carcinoids occur in association with mature cystic teratoma or are metastatic to the ovary. A 48-year-old post-menopausal woman presented with progressive facial puffiness, and intractable diarrhea. Radiological imaging suggested a 10 × 9 × 9.2 cm right ovarian mass. She underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathological examination revealed primary pure carcinoid tumor of the ovary with the synchronous presence of early invasive squamous cell carcinoma of the cervix, along with the icthyosis uteri. The patient is doing well on 5 years of follow-up post-surgery without any recurrence or metastasis. In this report, we intend to highlight the rare association of cervical carcinoma and ichthyosis uteri with this tumor. In addition, we present a short review of the literature, over a decade of ovarian carcinoids associated with carcinoid heart disease.

Elucidating the role of excision repair cross-complement group 1 in oral epithelial dysplasia and early invasive squamous cell carcinoma: An immunohistochemical study.

Objectives:Oral epithelial dysplasia (OED) is characterized by cellular alterations which have the proclivity of progressing to squamous cell carcinoma. Excision repair cross-complement group 1 (ERCC1) is one of the key proteins involved in nucleotide excision repair (NER) pathway. The expression of ERCC1 has been studied in colorectal, esophageal, ovarian and oral squamous cell carcinoma; but, very few studies have been done to apprehend the expression of ERCC1 in OED and early invasive squamous cell carcinoma (EISCC). The goal of this study is to evaluate the role of ERCC1 in OED and EISCC.Materials and Methods:Histopathologically diagnosed cases of moderate dysplasia (n = 10), severe dysplasia (n = 10) and EISCC (n = 10) were retrieved. 4 μ thick sections were cut from the formalin-fixed paraffin-embedded tissue blocks. The sections were immunohistochemically stained for ERCC1 following standard protocols. The expression of ERCC1 was evaluated semiquantitatively. Statistical analysis was carried out using Fischer's exact t-test.Results:The expression of ERCC1 was found to be strong (+3) in EISCC, moderate (+2) in severe dysplasia and mild (+1) in moderate dysplasia. Thus, the results were statistically significant between the three groups (P < 0.001).Conclusion:Disruption in the mechanisms that regulate cell cycle checkpoints and DNA repair mechanism results in genomic instability; these alterations might contribute to carcinoma. ERCC1 is essential to repair the DNA damage induced by various carcinogens. The present study shows significant difference in the expression of ERCC1 between EISCC and OED, which suggests ERCC1 could be used as one of the predictive markers.

Early invasive squamous cell carcinoma recurrence rates: A study examining surgical margins, tumor surface diameter, invasion depth, and grade of differentiation in 1296 cases over 9 years

Invasive squamous cell carcinoma (SCC) is typically treated by surgical excision. Consecutive SCC excisions were reviewed prospectively in a single Australian center from 2009 to 2017. Cases were examined for recurrence by histopathologic margins, microscopic tumor surface diameter, invasion depth, grade of differentiation, and anatomic site. Over 9 years, 1296 cases were collected. By grade of differentiation maximum average microscopic surface diameters ranged from 8.0 to 9.6 mm and maximum average depths from 1.3 to 2.5 mm. Minimum average histopathologic margins for well, moderate, and poorly differentiated SCC, respectively, were 1.4, 1.1, and 1.3 mm. Recurrence occurred in 1.7% of well (n = 18/1084), 1.8% moderate (n = 3/165) and 6.4% in poorly differentiated (n = 3/47) SCC. No recurrence occurred beyond a histopathologic margin of 3.5 mm for well and 2.5 mm for moderately differentiated SCC. Highest recurrence for well-differentiated SCC by anatomic site was the lip (7.0%) then ear (4.6%). We found a recurrence rate of 1.0% for histopathologic margins of 1.5 mm with early well-differentiated SCC. The grade of differentiation and anatomic site had a larger influence on recurrence rates compared to the histopathologic margins. Poorly differentiated SCC and ear or lip sites require wider surgical margins.

SPARC is associated with carcinogenesis of oral squamous epithelium and consistent with cell competition.

The matricellular protein, secreted protein acidic and rich in cysteine (SPARC) is thought to be involved in cell competition. The objective of this study is to investigate the role of SPARC in cancerization of oral squamous epithelium. Clinical specimens from 57 pre- and early cancerous lesion, 66 invasive squamous cell carcinoma (SCC) and controls were immunostained with SPARC. Clinical features and SPARC expression were evaluated. Furthermore, effects of SPARC knockdown and overexpression were examined in oral cancer and keratinocyte cell lines. Leukoplakia, carcinoma in situ, and early invasive SCC had more SPARC-positive cells than normal mucous epithelium. However, there were no significant differences between leukoplakia, carcinoma in situ, and early SCC, and there were no correlations between SPARC immunoreactivity and prognosis of invasive oral SCCs. Cell proliferation was down-regulated by SPARC siRNA, and enhanced by SPARC transformed keratinocytes. But SPARC overexpression did not enhance cell migration activity. SPARC is induced by dysplastic cells in the early stage of cancerization, and may improve survival capability, but is not involved in malignancy. SPARC may act to escape from elimination by cell competition.

PPO.47 Radical Vaginal Trachelectomy for Cervical Cancer during pregnancy and subsequent obstetric outcome

Radical Vaginal Trachelectomy (RVT) is a fertility sparing technique first described by D’Argent in 1994.1 This involves removal of the cervix and parametrial tissue, laparoscopic bilateral pelvic lymph node dissection...

White lesion: A dormant malignancy?

Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disease that frequently involves the oral mucosa. The authors report a long-term follow-up of a case which presented clinically as lichen planus with apparently benign features but histologically exhibited features of early invasive squamous cell carcinoma. Although a common lesion, the matter concerning malignant potential of OLP and its differentiation from lichenoid reaction still remains unresolved. There is no universally accepted, documented, and approved modality of treatment to prevent the occurrence of cancer development and also literature search reveals no standard methods which can predict cancer development of potentially malignant disorders. Hence every reported case should be well documented. This case report emphasizes the need for histological confirmation, with continuous monitoring 3-6 times annually of clinical lesions that have lichenoid features.

Interventions for cutaneous Bowen's disease.

Bowen's disease is the clinical term for in situ squamous cell carcinoma of the skin. Cutaneous lesions present as largely asymptomatic, well-defined, scaly erythematous patches on sun-exposed skin. In general, people with Bowen's disease have an excellent prognosis because the disease is typically slow-growing and responds favourably to treatment. Lesions are persistent and can be progressive, with a small potential (estimated to be 3%) to develop into invasive squamous cell carcinoma. The relative effectiveness of the available treatments is not known for Bowen's disease, and this review attempts to address which is the most effective intervention, with the least side-effects, for cutaneous Bowen's disease. To assess the effects of therapeutic interventions for cutaneous Bowen's disease. We searched the following databases up to September 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, Issue 9), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1806), and LILACS (from 1982). We also searched online trials registers. We checked the bibliographies of included and excluded studies and reviews, for further references to relevant randomised controlled trials (RCTs). We included all randomised controlled trials assessing interventions used in Bowen's disease, preferably histologically proven. Two authors independently carried out study selection and assessment of methodological quality. The primary outcome measures were complete clearance of lesions after the first treatment cycle and recurrence rate at 12 months. Our secondary outcomes included the number of lesions that cleared after each treatment cycle, the number of treatment cycles needed to achieve clearance, the recurrence rates at > 12 months, cosmetic outcome, quality of life assessment, and adverse outcomes as reported by both participant and clinician.We included 9 studies, with a total of 363 participants. One study demonstrated statistically significantly greater clearance of lesions of Bowen's disease with MAL-PDT (methyl aminolevulinate with photodynamic therapy) when compared with placebo-PDT (RR (risk ratio) 1.68, 95% CI (confidence interval) 1.12 to 2.52; n = 148) or cryotherapy (RR 1.17, 95% CI 1.01 to 1.37; n = 215), but there was no significant difference when MAL-PDT was compared to 5-FU (5-fluorouracil). One study demonstrated statistically significantly greater clearance of lesions with ALA-PDT (5-aminolevulinic acid with photodynamic therapy) versus 5-FU (RR 1.83, 95% CI 1.10 to 3.06; n = 66), but no statistically significant difference in recurrence rates at 12 months (RR 0.33, 95% CI 0.07 to 1.53).Cryotherapy showed no statistically significant difference in clearance rates (RR 0.99, 95% CI 0.78 to 1.26) or recurrences at 1 year (RR 1.48, 95% CI 0.53 to 4.17) when compared to 5-FU in 1 study of 127 participants.One study compared imiquimod to placebo and demonstrated statistically significantly greater clearance rates in the imiquimod group (9/15 lesions) compared to placebo (0/16) (Fisher's Exact P value < 0.001). The imiquimod group did not report any recurrences at 12 months, but at 18 months, 2/16 participants in the placebo group had developed early invasive squamous cell carcinoma. Overall, there has been very little good-quality research on treatments for Bowen's disease. There is limited evidence from single studies to suggest MAL-PDT is an effective treatment. Although cosmetic outcomes appear favourable with PDT, five-year follow-up data are needed. Significantly more lesions cleared with MAL-PDT compared to cryotherapy. No significant difference in clearance was seen when MAL-PDT was compared with 5-FU, but one study found a significant difference in clearance in favour of ALA-PDT when compared to 5-FU. There was no significant difference in clearance when cryotherapy was compared to 5-FU.The lack of quality data for surgery and topical cream therapies has limited the scope of this review to one largely about PDT studies. The age group, number, and size of lesions and site(s) affected may all influence therapeutic choice; however, there was not enough evidence available to provide guidance on this. More studies are required in the immunosuppressed populations as different therapeutic options may be preferable. Specific recommendations cannot be made from the data in this review, so we cannot give firm conclusions about the comparative effectiveness of treatments.

3. Outcome of excision of early invasive squamous carcinomas of the anal canal and perianus

Background Combined modality therapy (CMT) is the standard of care for anal canal (AC) squamous cell carcinoma (SCCA); excision is reserved for small perianal (PA) cancers. Increasingly, asymptomatic, superficially invasive SCCAs (SISCCA) are identified during high-resolution anoscopy (HRA). For AC- and PA-SISCCA, the Lower Anogenital Squamous Terminology Project’s proposed definition is an excised tumour with clear margins, depth of invasion &lt;3 mm, and horizontal extent &lt;7 mm. We report our experience with surgical excision alone of early invasive SCCA (EISCCA), defined as AC- or PA-SISCCA and &gt;SISCCA, but with clear margins. Methods: EISCCA were excised sparing the anal sphincter and anal high-grade squamous intraepithelial lesions (HSIL) were ablated. Those with margins positive for SCCA were referred for CMT. HRA was performed every 4 months; recurrent HSIL/EISCCA was ablated or excised. Patients were referred for CMT if cancer could not be excised without compromising the sphincter. Results: EISCCA was excised in 81 patients: 68 men and 13 women, 57 HIV-infected and 24 HIV-uninfected. Median age was 52 years (range: 33–79). Patients were followed for a median of 43 months (range: 2–230) following excision. Excision of EISCCA was successful in 73 (90%) patients. Eight (10%) required CMT (4 developed inguinal node recurrences, including 2 with systemic metastases). There was no statistically significant difference in outcome by location (AC v. PA EISCCA), HIV status or sex (P &gt; 0.05). Conclusions: Excision of EISCCA, including AC tumours, produces an excellent outcome, sparing most patients CMT, including those with HIV infection.

Lower Anogenital Tract Squamous Terminology

Lower Anogenital Tract Squamous Terminology

Early invasive squamous cell carcinoma of the tongue

Oral cancer is the sixth most common cancer for both sexes in the general population. Squamous cell carcinoma is defined as a malignant epithelial neoplasm exhibiting squamous differentiation as characterized by the formation of keratin and/ or the presence of intercellular bridges (Pindborg et al., 1977).[1] It is the most common neoplasm of the oral cavity. We present a case of oral SCC emphasizing on the invasive nature of the lesion and importance of correct biosy and histopathological examination.

Expression of type IV collagen in different histological grades of oral squamous cell carcinoma: An immunohistochemical study

The aim of this study was to evaluate the expression of type IV collagen in three histological grades of oral squamous cell carcinoma (SCC) in comparison with that in normal oral mucosa, to determine whether this protein can be used as a marker in early detection of the biological behavior of phenotypically altered cells. The staining intensity, staining pattern, and distribution mode for type IV were compared among the four groups by two pathologists, and the differences between observers and disease groups were statistically analyzed by Chi-square test or Fisher's exact test. The type IV staining intensity was more enhanced in well-differentiated (w) SCC than poorly-differentiated (p) SCC (P = 0.004). The staining was more linear (P = 0.001) and continuous (P = 0.003) in early invasive SCCs than in highly invasive SCCs. Its distribution was more continuous in wSCC than in less differentiated SCC (P = 0.003). There were statistically significant differences in the staining intensity between wSCC and pSCC (P = 0.005) or between wSCC and moderately differentiated SSC (P = 0.003) and in the staining pattern between wSCC and pSCC (P = 0.001). The results indicated that there was a direct relationship between the presence of type IV collagen and the differentiation degree of SCC cells and thus that SCC cells loose their capability to form the basement membrane as they become less differentiated.

White lesions of the oral mucosa

White lesions of the oral mucosa are a common clinical finding that often present first to general dentist. Some white lesion may have possibility of malignancy. Leukoplakia is the most common "potentially malignant disorder" of the oral mucosa. Leukoplakia is at present defined as "A white plaque of questionable risk having excluded (other) known disease or disorders that carry no increased risk for cancer.". Therefore, it is important for general dentist to be familiar to clinical differential diagnosis of leukoplakia from the known white lesions such as candidiasis, lichen planus, leukoedema, frictional keratosis, and so on. It is also important to decide whether such lesions require further investigation through the biopsy. As a result of biopsy, the presence of epithelial dysplasia in the leukoplakia is still the strongest predictor of future malignant transformation. In this article, oral white lesions that must be differentiated from potentially malignant disorders or early invasive squamous cell carcinoma will be reviewed together with presenting clinical cases.

Complications following interventional laser surgery for oral cancer and precancerous lesions

Interventional carbon dioxide laser surgery is the preferred method to treat oral precancerous lesions and early invasive squamous cell carcinomas (SCCs). Little is known, however, about the complications that patients experience after such treatment. We retrospectively reviewed the hospital records of 82 patients with new dysplastic oral lesions or early invasive oral SCCs treated by laser surgery in the maxillofacial unit at Newcastle General Hospital. The most common postoperative complications were pain for more than two weeks after operation (n=28), bleeding (n=4), difficulties with speech (n=5), paraesthesia of the lingual nerve (n=17), difficulty swallowing (n=2), obstructive swelling of the submandibular gland (n=22), and tethering of the tongue (n=10). Overall, 78% of patients had one or more complication. In the absence of randomised controlled trials, this study provides the best available evidence for complication rates following interventional surgery. In addition to aiding in the preoperative counselling of patients, the data will help to inform and advise patients particularly during the immediate postoperative period.