Oral premalignancy: new methods of detection and treatment

Abstract

Oral carcinogenesis proceeds through a stepwise accumulation of genetic damage over time. Because the oral cavity is easy to examine and risk factors for oral cancer are known, there is great opportunity to improve patient outcomes through diagnosis and treatment of pre-malignant lesions before the development of invasive oral carcinoma. This review provides a summary of developments in detection and diagnosis of oral premalignant lesions and innovative approaches to management of early oral neoplasia. These technological and therapeutic advances are much needed to improve the poor outcomes associated with oral cancer due to our inability to diagnose and treat this disease at an early, curable stage.

Figure 1

Diagram of the optical interactions involved in fluorescence spectroscopy. Light at a specific excitation wavelength illuminates the tissue and interacts with structures and molecules. Some light is absorbed by molecules such as hemoglobin, or scattered by nuclei or other structures, but some light reaches native fluorophores within the tissue. Fluorophores, when excited by photons in light, emit energy in the form of fluorescence, which can be detected when it reaches the tissue surface. FAD—flavin adenine dinucleotide; NADH—nicotinamide adenihsucleotide.

Figure 2

Images of normal (A) and neoplastic (B) oral mucosa taken with a confocal microscope are shown. Nuclei are highly reflectant and appear white. Notice the irregularity of nuclear size and shape and increased nuclear-to-cytoplasmic ratio in the neoplastic mucosa (B).