· The necessity of being aware of the entire range of white lesions that affect oral mucosa including some potentially malignant (PM) lesions to avoid over treatment.
· Lesions such as leukoedema, frictional keratosis, morsicatio, smokers palate, chemical burns and white spongy nevus need to be differentiated from leukoplakia, lichen planus, lichenoid lesions and oral sub mucous fibrosis.
· Clinical differentiation of the lesions with and without out malignant potential require a biopsy. However knowledge of specific features can assist in identifying high risk white lesions and surface changes.
· A lesion should be suspected to be innocuous when :
o Appears
in an unlikely site for Squamous cell
carcinoma( SCC)- like surface of tongue,
tip of tongue(plaque type Lichenplanus more common), gingiva and palate
o Occurs
in Children or the very young.
o Unlikely
morphology- Triangular and bilateral (most likely – cheek biting), Bilateral Retroangular
homogenous in heavy smokers,
o White
lesions that are scrapable, like Pseudomembranous candidiasis, which is wipable/scrapable.
o Lesions
identifiable as other entities such as
§ Smoker’s
palate or stomatitis nicotina palatini. (It is caused by heat rather than the
nicotine and the site may be more resistant to malignant change due to heavy
keratinization of the palate)
§ Smoker’s
melanosis dark brownish black minute spots on mucosa first described by Swedish
researcher Heldin. Heavy smokers may
show bilateral brownish tinge of OMM
that shows no malignant transformation
·
Optimal management –
·
Biopsy/s to rule out/identify/grade dysplastic
change.
·
Early intervention… Best approach is removal by CO2 laser.
·
No known treatment that can prevent malignant
transformation therefore, recall
important
o Homogenous leukoplakia – 3-6 months
o Homogenous leukoplakia – 3-6 months
o Non
homogenous leukoplakia – 6- 12 months
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