Premalignant Lesions and Their Link to Oral Cancer

Did you know October is cancer awareness month?

Well, let us look at a group of conditions called premalignant lesions that have a very high risk of transforming into actual malignant lesions (what we fear most and what is known as CANCER). Frightening? The good news is that these conditions can be managed thus preventing the transformation into malignant cancer.

Premalignant Lesions

1. Leukoplakia

This appears as a white patch or plaque accumulated on the tongue or palate or mucosa that can’t be scrapped off and is attributed to no other cause other than tobacco smoking. It has a high incidence of 30% of progressing to malignant forms. Management is key including performing a biopsy and surgical management depending on the severity.

2. Erythroplakia

This is a well-demarcated area that appears as a red patch on the oral tissues attributed to tobacco smoking and no other cause.  It should not be ignored since it has the highest risk of malignant transformation at 85%.

3. Lichen planus

This condition appears as a reticular/leaf-like pattern of thickened epithelium seen on the buccal mucosa bilaterally. It affects females more than males. It is considered an autoimmune condition with a high chance of malignant transformation.

4. Submucous fibrosis

This condition appears as tanning/tightening of the oral mucosa caused by chewing betel leaf or areca nut also called Indian tobacco. This leads to the paleness of the mucosa with fibrosis leading to difficulty in opening the mouth. Malignant transformation is seen in 30%.

5. Plummer-Vinson syndrome

This is caused by iron deficiency anemia associated with difficulty swallowing, spoon-shaped nails, and angular cheilitis. A weblike membrane forms on the esophagus that causes dysphagia. It is common among middle-aged women and also has a high risk of malignant transformation.

6. Actinic Cheilitis

This appears as dry, cracked and thickening of the vermilion border of the lips due to constant lip inflammation as a result of excessive sun exposure. It is more common in men and affects the lower lip. It is also a premalignant lesion.

Risk Factors for Oral Cancer

These are habits/agents/behaviours/characteristics that increase the likelihood of an individual developing cancer. they can either be modifiable or non-modifiable.

Modifiable Risk Factors

1. Tobacco
2. Alcohol
3. Betel leaf or areca nut
4. Excessive sun exposure
5. Viral infections e.g HPV
6. Vitamin Deficiency e.g Vitamins A, C, E
7. Immunosuppression
8. Exposure to radiation e.g x-rays
9. Chemicals e.g asbestos, silica

Non-Modifiable Factors

-Genetics

Management and Prevention of Oral Cancer

1. Proper evaluation and investigation with a qualified dental surgeon or maxillofacial surgeon

2. Biopsy and histology of the lesion- A small section of the diseased area is cut and investigated microscopically with an oral pathologist

• Risk factors have to be avoided and stopped e.g use of tobacco, areca nut

3. Surgical management with constant review

Prevention

• Annual screening of individuals exposed to any other risk factors for cancer
• Early detection
• Comprehensive medical facilities
• Public education