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Review
. 2014 Jul 1;19(4):e386-90.
doi: 10.4317/medoral.20205.

Oral potentially malignant disorders: is malignant transformation predictable and preventable?

Isaäc van der Waal  1
Affiliations
Review

Oral potentially malignant disorders: is malignant transformation predictable and preventable?

Isaäc van der Waal. Med Oral Patol Oral Cir Bucal. .

Abstract

Leukoplakia is the most common potentially malignant disorder of the oral mucosa. The prevalence is approximately 1% while the annual malignant transformation ranges from 2% to 3%. At present, there are no reliable clinicopathological or molecular predicting factors of malignant transformation that can be used in an individual patient and such event can not truly be prevented. Furthermore, follow-up programs are of questionable value in this respect. Cessation of smoking habits may result in regression or even disappearance of the leukoplakia and will diminish the risk of cancer development either at the site of the leukoplakia or elsewhere in the mouth or the upper aerodigestive tract. The debate on the allegedly potentially malignant character of oral lichen planus is going on already for several decades. At present, there is a tendency to accept its potentially malignant behaviour, the annual malignant transformation rate amounting less than 0.5%. As in leukoplakia, there are no reliable predicting factors of malignant transformation that can be used in an individual patient and such event can not truly be prevented either. Follow-up visits, e.g twice a year, may be of some value. It is probably beyond the scope of most dentists to manage patients with these lesions in their own office. Timely referral to a specialist seems most appropriate, indeed.

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Conflict of interest statement

Conflict of interest statement: The authors have declared that no conflict of interest exist.

Figures

Figure 1
Figure 1
Homogeneous leukoplakia in a 57-year-old man A). A biopsy showed hyperkeratosis without epithelial dysplasia. The patient was unable to stop smoking and refused any type of treatment. He was lost to follow-up and showed up 12 years later with a large squamous cell carcinoma B).
Figure 2
Figure 2
A 61-year-old woman with homogeneous leukoplakia in the floor of the mouth A). A biopsy showed hyperkeratosis without epithelial dysplasia. Treatment consisted of CO2 laser evaporation, resulting in an apparently good result after 6 months B). Six years later the leukoplakia had recurred C).
Figure 3
Figure 3
A 63-year-old man with verrucous leukoplakia of the buccal mucosa A). The leukoplakia recurred within three weeks after surgical removal B).
See this image and copyright information in PMC

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