Oral Verrucous Hyperplasia Research Articles

Efficacy of Aminolevulinic Acid Mediated Photodynamic Therapy in the Treatment of Oral Premalignant Lesions: A Systematic Review.

Aminolevulinic acid (ALA) mediated photodynamic therapy (PDT) is considered as an effective treatment option for oral premalignant lesions. ALA is a Food and Drug Administration (FDA) approved second-generation photosensitizer (PS) used both orally as well as topically. This systematic review aims to evaluate the efficacy of ALA-PDT for the treatment of oral premalignant lesions. The focused question was, "Is ALA-PDT effective in the treatment of oral premalignant lesions?"A literature search was made in PubMed/Medline and GoogleScholar using different combinations of the following keywords: photodynamic therapy, oral premalignant lesions, oral leukoplakia (OL), erythroplakia, oral erythroleukoplakia (OEL), oral verrucous hyperplasia (OVH); and oral lichen planus (OLP). Review articles, preclinical studies, case-reports, commentaries, letters to the Editor, unpublished articles, studies on photodynamic therapy used in areas other than the oral cavityand, articles published in languages other than English were excluded. The relevant information was summarized. There were initially 64 results for the above parameters; 47 studies were excluded, leaving 17 studies for analysis. Characteristics of the included studies, PS, and PDT protocol were summarized. The outcome of the included studies suggested that ALA-PDT is an effective, easy to perform technique, well tolerated treatment with encouraging achievements in the treatment of oral premalignant lesions. No systemic side effects and skin photosensitivity were reported with topical ALA even within initial 48 hours after PDT, and patients were not required to avoid exposure to light following treatment. The clinical outcome of the ALA-PDT application, as reported in the studies, was also very promising, with either diminution in the size of the lesion or complete remission or improvement in signs and symptoms as well as reduced recurrence.

Exploring the Role of EZH2 and BCL2 in Demarcating Oral Verrucous Hyperplasia and Verrucous Carcinoma

Introduction Oral verrucous hyperplasia (OVH) and verrucous carcinoma (OVC) are precursors of oral squamous cell carcinoma exhibiting overlapping histopathological picture which warrants distinction. EZH2 is an epigenetic marker possessing multifaceted function in cellular proliferation, migration, and malignant transformation, whereas BCL2 is an integral part of the antiapoptotic mechanism regulating cellular homeostasis. Aim The aim was to distinguish OVH and OVC by analysis of immunohistochemical expression of EZH2 and BCL2. Material and Methods The study sample consisted of 79 formalin-fixed paraffin-embedded tissue sections of normal oral mucosa (10), OVH (10), oral OVC (27), and oral squamous cell carcinoma (32). Immunohistochemical analysis of EZH2 and BCL2 was done and labeling indices were calculated. Additionally, six histopathological parameters were assessed in OVH and OVC. Statistical analysis was done using Kruskal–Wallis test, Tukey honest significant difference test, and Spearman's correlation. Receiver operating characteristic curve was plotted and sensitivity, specificity, and cutoff score of each marker were calculated. Result and Discussion Labeling indices of EZH2 and BCL2 depicted a gradual incline from normal mucosa to oral squamous cell carcinoma. Significant difference of EZH2 and nonsignificant difference in BCL2 expression between OVH and OVC were noted. Out of the six histopathological parameters, keratin plugging, juxtaepithelial lymphocytic response, and frank endophytic growth yielded a significant difference. EZH2 serves as a superior marker than BCL2 to differentiate OVH and OVC. Juxtaepithelial lymphocytic response can also serve as a histopathological parameter in distinguishing OVH and OVC.

Efficacy of Photodynamic Therapy in the Treatment of Oral Premalignant Lesions: A Systematic Review

Abstract Photodynamic therapy (PDT) is considered a contemporary effective treatment option for oral premalignant lesions. This systematic review aims to evaluate the usefulness of PDT for the treatment of oral premalignant lesions. The focused question was “Is PDT effective in the treatment of oral premalignant lesions?” A literature search was made in PubMed/Medline and Google Scholar databases using different combinations of the following keywords: photodynamic therapy, oral premalignant lesions, oral leukoplakia (OL), erythroplakia, oral erythroleukoplakia (OEL), oral verrucous hyperplasia (OVH), and oral lichen planus (OLP). Review articles, preclinical studies, case reports, commentaries, letters to the editor, unpublished articles, studies on photodynamic therapy used in areas other than oral cavity, and articles published in languages other than English were excluded. The relevant information were summarized. Initial results were 23. Twenty-two studies were included. Oral premalignant lesions, which were investigated, were OL, erythroplakia, OEL, OVH, and OLP. The studies used either laser light or light-emitting diode. Photosensitizers used were aminolevulinic acid, chlorine-e6, meta-tetrahydroxyphenylchlorin, methylene blue, toluidine blue, methyl 5-aminolevulinate cream, and phenothiazine chloride. Study outcomes and recurrence rates were evaluated. PDT is an effective treatment option. Topical PDT is an easy-to-perform technique, well-tolerated treatment with encouraging achievements in the treatment of premalignant lesions.

Photodynamic Therapy of Oral Cancer and Novel Liposomal Photosensitizers

Photodynamic therapy facilitates the selective destruction of cancer tissue by utilizing a photosensitizer drug, the light near the absorbance wavelength of the drug, and oxygen. Methylene Blue, 5-aminolevulinic acid (the precursor of the photosensitizer, protoporphyrin IX), porphyrin, Foscan, Chlorin e6, and HPPH have been used successfully as photosensitizers in the treatment of oral verrucous hyperplasia, oral leukoplakia, oral lichen planus, and head and neck squamous cell carcinoma. “Theranostic” liposomes can deliver a contrast agent for magnetic resonance imaging and a photosensitizer for the image-guided photodynamic therapy of head and neck cancer. Liposomes incorporating photosensitizers can be targeted to cell surface markers overexpressed on cancer cells. Novel porphyrinoids have been developed in our laboratories that are highly effective as photosensitizers. Tribenzoporphyrazines encapsulated in cationic liposomes have produced IC50 values up to 50 times lower compared to the free photosensitizers. It is anticipated that targeting these drugs to cancer stem cells, using upconversion nanoparticles for the near-infrared irradiation of tumors to activate the photosensitizers, and overcoming tumor hypoxia will enhance the efficacy of photodynamic therapy of tumors accessible to light sources.

Significantly higher serum levels and positive rates of tumor biomarkers in patients with oral lichen planus

Background/purposeOral lichen planus (OLP) is generally considered as an oral potentially malignant disorder (OPMD). Previous studies have shown significantly higher serum carcinoembryonic antigen (CEA), squamous cell carcinoma-antigen (SCC-Ag), and ferritin levels in patients with OPMDs such as oral submucous fibrosis, oral leukoplakia, oral erythroleukoplakia, or oral verrucous hyperplasia. This study aimed to evaluate whether there were significantly higher serum levels and positive rates of CEA, SCC-Ag, and ferritin in OLP patients than in healthy control subjects. Materials and methodsThe serum CEA, SCC-Ag, and ferritin levels in 106 OLP patients and 187 healthy control subjects were measured and compared. Patients with serum CEA level ≥3 ng/mL, SCC-Ag level ≥2 ng/mL, and ferritin level ≥250 ng/mL were scored as serum positive for CEA, SCC-Ag, and ferritin, respectively. ResultsThis study found significantly higher mean serum CEA and ferritin levels in 106 OLP patients than in 187 healthy control subjects. Moreover, 106 OLP patients had significantly higher serum positive rates of CEA (12.3%) and ferritin (33.0%) than 187 healthy control subjects. Although the mean serum SCC-Ag level was higher in 106 OLP patients than in 187 healthy control subjects, the difference was not statistically significant. Of the 106 OLP patients, 39 (36.8%), 5 (4.7%), and 0 (0.0%) had serum positivities of one, two, or three tumor biomarkers including CEA, SCC-Ag, and ferritin, respectively. ConclusionOur findings indicate significantly higher serum levels and positive rates of CEA and ferritin in OLP patients than in healthy control subjects.

Malignant transformation of oral potentially malignant disorders in Taiwanese indigenous peoples: A nationwide retrospective cohort study.

Malignant transformation of oral potentially malignant disorders (OPMDs) is a potential cause of oral cancer. Currently, there is no research investigating the rate of malignant transformation of OPMDs into oral cancer in indigenous Taiwanese peoples. This study aimed to retrospectively investigate whether ethnicity (indigenous vs non-indigenous people) plays a role in increasing the malignant transformation rate of OPMDs into oral cancer. This study used data from the oral mucosal screening database and the Cancer Registry File, both of which originated from the National Health Insurance Research Database. We matched the baseline characteristics to control for confounding factors between indigenous peoples and non-indigenous peoples (17,768 indigenous subjects vs 71,072 non-indigenous subjects; 1:4 match) and compared the 2 cohorts. After matching for confounding factors such as age, sex, habits, and OPMD subtype, the malignant transformation rate was not statistically higher for indigenous people than for non-indigenous people. We also discovered that indigenous people with oral verrucous hyperplasia might have a higher chance of malignant transformation into oral cancer than the non-indigenous cohort. We conclude that ethnicity is not a risk factor for the malignant transformation of OPMDs into oral cancer; however, indigenous people with oral verrucous hyperplasia need to pay special attention and are suggested to undergo regular follow-ups for the occurrence of oral cancer.

The Effect of Photodynamic Therapy on Oral-Premalignant Lesions: A Systematic Review.

BackgroundDentists now have access to a wide range of unique treatment methods as a result of substantial scientific and technological breakthroughs in the field of dentistry. Photodynamic therapy (PDT) is a non-invasive treatment procedure that use photosensitizers, a specific wavelength of light, and the production of singlet oxygen and reactive oxygen species (ROS) to kill undesired eukaryotic cells (such as oral tumors) and harmful microbes. In several disciplines of dentistry, it is seen as a valid therapeutic option. The purpose of this study was to examine the effectiveness and side effects of PDT in the treatment of oral premalignant lesions. Material and MethodsThree search engines (PubMed, ISI Web of Science, and the Cochrane Library) were used to conduct a systematic review using the phrases photodynamic therapy and PDT in combination with other terms. To define our study eligibility criteria, we used the Population, Intervention and Comparison, Outcomes, and Study design technique. ResultsInitial results were 33. Definitely, 18 studies met our selection criteria. ConclusionsOur analysis suggests ALA- PDT as a promising therapeutic modality for OEL lesions which should be treated first with the topical ALA-PDT using either the LED or laser light for successful clinical outcome for OEL lesions. Key words:Photodynamic Therapy, Photosensitizer, Aminolevulinic Acid (ALA), Methylene Blue (MB), Toludine Blue, Oral Leukoplakia, Oral Erythroplakia, Oral Verrucous hyperplasia, Oral Lichen Planus.

Association of HPV and EBV in Oral Verrucous Squamous Cell Carcinoma and Oral Verrucous Hyperplasia

Objective Oral verrucous squamous cell carcinoma or oral verrucous carcinoma (OVC) is a rare verrucous variant of oral squamous cell carcinoma (OSCC), which accounts for 2 to 12% of all oral carcinomas. Oral verrucous hyperplasia (OVH) is clinically similar to OVC and has been proposed to be a precursor lesion of OVC. Etiopathogenesis of both lesions is still inconspicuous. Oncogenic viruses such as human papillomavirus (HPV) and Epstein–Barr virus (EBV) have been reported to be associated with some cases of OSCC, and we hypothesized that it may act as a causative agent of these verrucous lesions. This study aimed to investigate frequency of HPV and EBV infections in OVC and OVH. Material and Methods Using polymerase chain reaction (PCR), a total of 35 formalin-fixed paraffin-embedded (FFPE) tissue samples, including 27 OVC samples and 8 OVH samples, were investigated for HPV and EBV infection. HeLa and B95-8 cell lines were used as positive controls of HPV and EBV PCR, respectively. Results All OVC and OVH samples show a positivity to GAPDH , whereas neither HPV nor EBV PCR products was detected in both OVC and OVH samples. Conclusions In summary, our study demonstrated that HPV and EBV are not involved in pathogenesis of OVC and OVH. Other etiologic factors contributing to OVC and OVH need to be further clarified.

Taxonomic and Functional Dysregulation in Salivary Microbiomes During Oral Carcinogenesis.

Exploring microbial community compositions in humans with healthy versus diseased states is crucial to understand the microbe-host interplay associated with the disease progression. Although the relationship between oral cancer and microbiome was previously established, it remained controversial, and yet the ecological characteristics and their responses to oral carcinogenesis have not been well studied. Here, using the bacterial 16S rRNA gene amplicon sequencing along with the in silico function analysis by PICRUSt2 (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States 2), we systematically characterized the compositions and the ecological drivers of saliva microbiome in the cohorts of orally healthy, non-recurrent oral verrucous hyperplasia (a pre-cancer lesion), and oral verrucous hyperplasia–associated oral cancer at taxonomic and function levels, and compared them with the re-analysis of publicly available datasets. Diversity analyses showed that microbiome dysbiosis in saliva was significantly linked to oral health status. As oral health deteriorated, the number of core species declined, and metabolic pathways predicted by PICRUSt2 were dysregulated. Partitioned beta-diversity revealed an extremely high species turnover but low function turnover. Functional beta-diversity in saliva microbiome shifted from turnover to nestedness during oral carcinogenesis, which was not observed at taxonomic levels. Correspondingly, the quantitative analysis of stochasticity ratios showed that drivers of microbial composition and functional gene content of saliva microbiomes were primarily governed by the stochastic processes, yet the driver of functional gene content shifted toward deterministic processes as oral cancer developed. Re-analysis of publicly accessible datasets supported not only the distinctive family taxa of Veillonellaceae and Actinomycetaceae present in normal cohorts but also that Flavobacteriaceae and Peptostreptococcaceae as well as the dysregulated metabolic pathways of nucleotides, amino acids, fatty acids, and cell structure were related to oral cancer. Using predicted functional profiles to elucidate the correlations to the oral health status shows superior performance than using taxonomic data among different studies. These findings advance our understanding of the oral ecosystem in relation to oral carcinogenesis and provide a new direction to the development of microbiome-based tools to study the interplay of the oral microbiome, metabolites, and host health.

Significantly higher serum tumor marker levels in patients with oral submucous fibrosis

Background/purposeOur previous study showed that carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC–Ag), and ferritin are significantly higher in patients with oral potentially malignant disorders (OPMDs including oral leukoplakia, oral erythroleukoplakia, and oral verrucous hyperplasia) than in healthy controls (HCs). Oral submucous fibrosis (OSF) is also recognized as an OPMD. This study evaluated whether these three serum tumor marker levels were also significantly higher in OSF patients than in HCs.Materials and methodsThe serum CEA, SCC-Ag, and ferritin levels in 41 OSF patients and 164 HCs were measured and compared. Patients with serum CEA level ≥3 ng/mL, SCC-Ag level ≥2 ng/mL, and ferritin level ≥250 ng/mL were scored as serum positive for CEA, SCC-Ag, and ferritin, respectively.ResultsWe found significantly higher mean serum CEA, SCC-Ag, and ferritin levels in 41 OSF patients than in 164 HCs (all P-values < 0.05). Moreover, 41 OSF patients had significantly higher serum positive rates of CEA (39.0%), SCC-Ag (19.5%), and ferritin (53.7%) than 164 HCs (all P-values < 0.05). Of the 41 OSF patients, 26 (63.4%), 7 (17.1%), and 2 (4.9%) had serum positivities of one, two, or three tumor markers including CEA, SCC-Ag, and ferritin, respectively.ConclusionThere are significantly higher mean serum CEA, SCC-Ag, and ferritin levels and significantly higher serum positive rates of CEA, SCC-Ag, and ferritin in OSF patients than in HCs. The serum CEA, SCC-Ag, and ferritin levels may be served as tumor markers for evaluation of malignant potential of OSF lesions.

Malignant transformation of oral potentially malignant disorders in Taiwan: An observational nationwide population database study.

Oral cancer is one of the leading causes of cancer death, which are mostly preceded by oral potentially malignant disorders (OPMDs). Taiwanese government launched a free oral cancer screening program. The aim of this study was to analyze the malignant transformation rate of OPMDs.This study was based on national-wide oral screening databases. 3,362,232 people were enrolled. Patients clinically diagnosed with leukoplakia, erythroplakia, oral submucosal fibrosis (OSF), oral verrucous hyperplasia (OVH), and oral lichen planus (OLP), from 2010 to 2013, were identified. We followed up OPMD patients in cancer registry databases to analyze the malignant transformation rate.The malignant transformation rates from the highest to the lowest were: OVH > OSF > erythroplakia > OLP > leukoplakia. The malignant transformation rate was 24.55, 12.76, 9.75, 4.23, and 0.60 per 1000 person-years in the OVH, OSF, erythroplakia, leukoplakia, and comparison cohort. The hazard ratio was 8.19 times higher in the OPMD group compared with comparison cohort group, after age and habit adjustment. Female patients with OPMDs had a high risk of malignant transformation.Nationwide screening is very important for early diagnosis. OVH had the highest malignant transformation possibility. Female OPMD patients are a rare but have a relatively high malignant transformation rate.

Differential Expression of EZH2 and H3K27me3 in Oral Verrucous Carcinoma and Oral Verrucous Hyperplasia.

Enhancer of zeste homolog 2 (EZH2), a component of the polycomb repressive complex 2 that catalyzes trimethylation of H3K27 (H3K27me3), has been shown to promote tumor development and progression. Expression of EZH2 is associated with cell cycle regulation and cell proliferation in various neoplasms. Oral verrucous hyperplasia (OVH) and Oral verrucous carcinoma (OVC) are rare entities and share several clinical and histopathologic features. Problems distinguishing these lesions are added by a lack of adjacent normal tissue of the biopsy samples and poorly oriented tissue sections. The aim of this study was to investigate the expression of EZH2 and H3K27me3 in OVH and OVC and comparing the expression with normal oral mucosa and oral squamous cell carcinoma (OSCC). Seventy-eight samples, including 25 cases of OVC, 8 cases of OVH, 35 cases of OSCC and 10 cases of normal oral mucosa, were retrieved and submitted for immunohistochemical staining. The results demonstrated that the mean labeling indices (LIs) of EZH2 and H3K27me3 expression were highest in OSCC, followed by the OVC, OVH, and normal mucosa. Statistical differences in EZH2 LI were observed among these lesions whereas H3K27me3 LI was significantly different among OSCC, OVH and normal mucosa. EZH2 LI was found to have a sensitivity of 72.00% and specificity of 87.50% in distinguishing OVH from OVC, and a sensitivity of 57.14% and specificity of 84.00% in distinguishing OVC from OSCC. A positive correlation between EZH2 and H3K27me3 expression was significantly found in OVC but not in OVH and OSCC. These findings highlight the involvement of epigenetic regulation by EZH2-mediated H3K27me3 in the pathogenesis of OVH and OVC, and EZH2 expression indicates disease progression of these verrucous lesions. Diagnostic test analysis further suggests that EZH2 may be used as an additional test for differentiating OVH from OVC in questionable cases.

Evaluation of the presence of myofibroblasts and matrix metalloproteinase 1 expression in the stroma of oral verrucous hyperplasia and verrucous carcinoma.

Oral verrucous carcinoma is a low-grade subtype of oral squamous cell carcinoma that should be differentiated from oral verrucous hyperplasia, a premalignant lesion. Stromal activated myofibroblasts known as cancer-associated fibroblasts have an active role in the initiation and progression of the cancers via secretion of different molecules including matrix metalloproteinases. This study is designed to understand the differences in the presence of myofibroblasts and expression of matrix metalloproteinase-1 in the adjacent stroma of verrucous carcinoma and oral verrucous hyperplasia (OVH). Cross-sectional study. Twenty-seven OVH, 19 oral verrucous carcinoma (OVC), and 8 cutaneous verrucous carcinoma (CVC) specimens were analyzed for immunohistochemical (IHC) expression of α-smooth muscle actin (αSMA) and MMP-1. IHC studies for αSMA expression in nonvascular stromal cells of the adjacent stroma revealed mild or no expression in 81.4%, 73.7%, and 62.5% of the cases of OVH, OVC, and CVC groups, respectively. No significant difference was seen in αSMA expression index between OVH and OVC groups (Adj. Sig. = 0.220) and between OVC and CVC groups (Adj. Sig. = 1.00). Pairwise analysis revealed a significant difference in MMP-1 expression index between the groups. No significant correlation was observed between MMP-1 expression index and αSMA expression index in OVH (pv = 0.358) and OVC (pv = 0.388) groups. The differences in MMP-1 expression between OVH and OVC can be used as an adjunctive aid in challenging cases including disoriented or inadequate samples.

Significantly higher frequencies of hematinic deficiencies and hyperhomocysteinemia in oral precancer patients

Our previous studies found relatively higher frequencies of anemia, hematinic deficiencies, and hyperhomocysteinemia in patients with different types of oral mucosal diseases. This study evaluated whether patients with oral precancerous lesions (oral precancer patients) had significantly higher frequencies of anemia, hematinic deficiencies, and hyperhomocysteinemia than healthy control subjects. The complete blood count, serum iron, vitamin B12, folic acid, and homocysteine levels in 131 oral precancer patients including 96 oral leukoplakia, 26 oral erythroleukoplakia, and 9 oral verrucous hyperplasia patients and in 131 age- and sex-matched healthy control subjects were measured and compared. We found significantly lower mean serum iron (for women only), vitamin B12, and folic acid levels and a significantly higher mean serum homocysteine level in oral precancer patients than in healthy control subjects (all P-values<0.05). Moreover, 131 oral precancer patients had significantly higher frequencies of blood hemoglobin (3.1%), vitamin B12 (43.5%), and folic acid (46.6%) deficiencies and hyperhomocysteinemia (22.1%) than 131 healthy control subjects (all P-values<0.05). Of 131 oral precancer patients, lower mean serum folic acid levels were found in 87 cigarette smokers than in 44 non-smokers (P=0.002), in 26 smokers consuming>20 cigarettes per day than in 61 smokers consuming≤20 cigarettes per day (P=0.024), and in 52 betel quid chewers than in 79 non-chewers (P=0.051). There are significantly higher frequencies of anemia, serum vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia in oral precancer patients than in healthy control subjects.

Gastric parietal cell and thyroid autoantibodies in oral precancer patients

Gastric parietal cell antibody (GPCA), thyroglobulin antibody (TGA), and thyroid microsomal antibody (TMA) may be present in oral mucosal disease patients. This study mainly assessed the frequencies of serum GPCA, TGA, and TMA positivities in 131 oral precancer patients. Serum GPCA, TGA, and TMA levels were measured in 131 oral precancer patients including 96 oral leukoplakia, 26 oral erythroleukoplakia, and 9 oral verrucous hyperplasia patients and in 131 age- and sex-matched healthy control subjects. We found that 131 oral precancer patients had higher frequencies of serum GPCA (10.7% vs. 2.3%, P=0.012, statistically significant), TGA (4.6% vs. 2.3%, P=0.498), and TMA (8.4% vs. 2.3%, P=0.054, marginal significance) positivities than 131 healthy control subjects. We also found that 1 (0.8%), 6 (4.6%), and 16 (12.2%) oral precancer patients had the presence of three (GPCA+TGA+TMA), two (GPCA+TGA, GPCA+TMA, or TGA+TMA), or one (GPCA only, TGA only, or TMA only) autoantibody in their sera, respectively. Of 10 TGA/TMA-positive oral precancer patients whose serum thyroid-stimulating hormone (TSH) levels were measured, 80%, 10%, and 10% of these 10 TGA/TMA-positive oral precancer patients had normal, lower, and higher serum TSH levels, respectively. We also found a significantly higher GPCA positive rate in 26 smokers consuming >20 cigarettes per day than in 61 smokers consuming ≤20 cigarettes per day (P=0.008). Approximately 17.6% of 131 oral precancer patients have serum GPCA/TGA/TMA positivity. Only approximately 20% of TGA/TMA-positive oral precancer patients have either hypothyroidism or hyperthyroidism.

Superficially Invasive Oral Squamous Cell Carcinoma Presenting With Features Of Oral Verrucous Hyperplasia – A Case Report

Brief Background : Verrucous lesions of the oral cavity with warty and exophytic clinical presentations can have varied histopathology. Oral Verrucous hyperplasia (OVH) is a potentially malignant disorder, which may transform into oral carcinoma. Case Report : We report a 56-year-old male patient who presented with a verruco-proliferative pinkish white growth on the lateral border of the tongue. The patient was diagnosed with superficially invasive squamous cell carcinoma in verrucous hyperplasia based on histopathological features. Summary and Conclusion : The diagnosis of this entity poses difficulty as it can be underdiagnosed as oral verrucous hyperplasia particularly in superficial biopsies. Key words : Verrucous hyperplasia, Squamous cell carcinoma, superficially invasive.

Is Topical Photodynamic Therapy with 5-ALA , using Tsai’s protocol , useful in the healing of oral potentially malignant disorders? A system-atic review of the literature

A Aim The present review was performed in order to assess the effect of topical photodynamic therapy with 5-ALA in pre-malignant lesions, using the Tsai’s protocol. Material and methods Studies, using the Tsai’s protocol with topical photodynamic therapy with 5-ALA, in oral potentially malignant disorders (oral leukoplakia, oral eryhtroplakia, oral verrucous leukoplakia, oral lichen planus) and with at least 5 months follow-up, were selected. The light source was: 635 nm laser light or LED red light at 635 nm. The main outcome measure was the healing of the potentially malignant disorders evaluated as Complete Response, Partial Response, No Response. Results Of the 12 eligible studies, five studies were included. Seven studies were excluded because they did not followe the Tsai’s protocol, 2 because the lesions were analyzed in other studies. The outcomes were: Oral Leucoplakia 7.7% complete response, 50.8% partial response, 41.5% no response; Oral Erythroplakia: 91,7% complete response, 8.3% partial response; Oral Verrucous Hyperplasia 100% complete response. Conclusions Within the limitation of the present systematic review, the selected studies suggested that 5-ALA PDT, using the fractionated Tsai’s protocol, had good results in the treatment of oral verrucous hyperplasia, less in erythroplakia and leukoplakia; this could be due to the different epithelial structure of the lesions. Further studies need to be conducted to confirm these data.

Oral Verrucous Hyperplasia: A Case Report

Oral Verrucous Hyperplasia is considered as an initialtype of verrucous carcinoma, representing a plausible malignant transformationof the oral mucous membrane. Studies have documented that verrucous hyperplasia transforms into verrucous carcinoma quite consistently and hence both theselesions should be managed identically. The present article reports the case of a 62-year-old male patient whoseprimary complaintwas that of a non-scrapableexophytic warty white outgrowth on edentulous alveolar ridge in the right upper posterior tooth region of the jaw. The growth was provisionally diagnosed as Squamous papilloma. Excision of the exophyticlesion was doneand the tissue biopsy sent for histopathological examination. Histopathologic examination suggested that the lesion was Oral Verrucous hyperplasia. 3 month follow-up of the patient revealed no signs of recurrence.

Exophytic verrucous hyperplasia in oral submucous fibrosis: A single-center study.

Introduction:The present study analyzed the occurrence of exophytic verrucous hyperplasia (EVH) in the background of oral submucous fibrosis (OSF), which presents clinically as a solitary verrucopapillary lesion (VPL) mimicking malignancy. We also aimed to obtain additional information on VELscope appearance and histopathological features of EVH.Materials and Methods:The prevalence of EVH in OSF background was assessed from January 2014 to December 2018 using VELscope and histopathological examination.Results:Six hundred and sixty-two OSF patients were examined. Thirteen patients presented with solitary VPL in OSF background. A VELscope examination found ten cases with increased autofluorescence (fluorescence visualization increase, FVI), two cases with autofluorescence loss (fluorescence visualization loss, FVL), whereas one case exhibited dual autofluorescence (focal areas of FVL within FVI regions). Histopathologic examination revealed two FVL cases as oral verrucous carcinoma (OVC) and oral squamous cell carcinoma (OSCC) and one dual autofluorescence case as OVC, while six FVI cases showed nondysplastic epithelium having verrucopapillary pattern without connective tissue invasion, consistent with the clinicopathological diagnosis of EVH.Conclusion:The present study demonstrated the evidence of EVH in OSF background, which on histopathological examination revealed nondysplastic epithelium exhibiting the verrucopapillary pattern. A VELscope examination of these lesions showed increased autofluorescence, suggesting its nonneoplastic nature of clinically malignant-looking exophytic VPLs in OSF background. Present study suggests newer perspective for using the term oral verrucous hyperplasia (OVH) and EVH with justification and also proposes to introduce new terminology such as oral verrucous dysplasia and exophytic verrucous dysplasia.

Porphyrinoids in photodynamic diagnosis and therapy of oral diseases

Photodynamic methods have found application not only in the treatment process as photodynamic therapy but also for the early detection of neoplastic lesions and tumors as photodynamic diagnosis. Early detection of the disease allows not only to avoid the patient’s lifetime risk but also significantly reduce the costs of anticancer therapy, which are increasing every year. There is a constant search for new and more effective photosensitizers which will provide safety in therapy while maintaining efficiency. This paper summarizes recent reports focused on the photodynamic diagnosis of oral cancers. Moreover, it shows methods of the photodynamic treatment of oral verrucous hyperplasia, erythroleukoplakia, and oral leukoplakia. The treatment of choice for these diseases is a surgical excision, which always leads to scar formation. Photodynamic therapy provides a new scar-less tool for the treatment.