Historical perspective and nomenclature of potentially malignant or potentially premalignant oral epithelial lesions with emphasis on leukoplakia—some suggestions for modifications

doi:10.1016/j.oooo.2017.11.023

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Volume 125, Issue 6, June 2018, Pages 577-581

https://doi.org/10.1016/j.oooo.2017.11.023 Get rights and content

Of the potentially (pre)maligant oral epithelial lesions, leukoplakia is the most common. A brief overview of the various definitions of leukoplakia that have been used in the past is presented here. A proposal has been made to modify the current definition. Clinically, for decades, leukoplakias have been divided into homogeneous and nonhomogeneous leukoplakias and further into different subtypes. A proposal has been made to slightly rearrange these subtypes. Furthermore, attention has been paid to a number of keratotic lesions that have been reported in the literature. It is expected that the increasing knowledge on carcinogenesis, including various genetic aspects, will be reflected in the definition of oral potentially (pre)malignant lesions in the near future.

Section snippets

Definition

In 2005, in another WHO-guided conference on the definition and terminology related to leukoplakia and leukoplakia-like (leukoplakic) lesions, the 1978 WHO definition was amended as follows: “The term leukoplakia should be used to recognize white plaques of questionable risk having excluded (other) known diseases or disorders that carry no increased risk for cancer.”⁹ It was added that leukoplakia is primarily a clinical term and has no specific histology. In Table I, a series of well-defined,

Preleukoplakia

There have been some reports in the literature on preleukoplakia, thought of as a precursor stage of leukoplakia and decribed as a gray or grayish-white area with indistinct borders blending into the adjacent normal mucosa.14, 15 This term may perhaps be applied to flat changes of the mucosa that are not white enough to qualify for the term leukoplakia.

Keratoses

The use of the term keratosis for a number of oral white lesions is somewhat confusing. In fact, keratosis is primarily a histologic term, used

Discussion and Some Suggestions for Modifications of the Definition of Leukoplakia and the Clinical Classification

In view of the increasing knowledge about carcinogenesis, including various genetic aspects, it is no surprise that suggestions already have been made to modify the definition of potentially (pre)malignantlesions and diseases. An example is the one provided by Sarode et al.: “It is a group of disorders of varying etiologies, usually tobacco, characterized by mutagen associated, spontaneous, or hereditary alterations or mutations in the genetic material of oral epithelial cells with or without

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Cited by (24)

Bibliometric analysis of the top-100 cited articles on oral potentially malignant disorders to guide research topic and direction
2020, Journal of Dental Sciences
Citation Excerpt :
Currently, preference is given to the term ‘potentially malignant’ instead of the terms ‘premalignant and precancerous’, was recommended at a workshop of the WHO Collaborating Centre held in 2005.1 It is a more precise term because there is no certainty that all precancerous lesions will eventually develop into cancer.1,2 Clinically, oral leukoplakia, erythroplakia, submucous fibrosis, lichen planus are individual disorders of OPMD.3
Bibliometric analysis highlights the key topics and studies which have shaped the understanding and management of a concerned disease. Here the top-cited articles on oral potentially malignant disorders (OPMD) were characterized and analyzed.
A comprehensive search was performed and identified in the Scopus database from 1941 to 10 March 2019 for the 100 most-cited articles on OPMD.
The number of citations of the 100 selected articles varied from 131 to 1422, with a mean of 240.6 citations per article. Molecular markers/targets, chemoprevention, and early detection and diagnosis of oral cancer were the top-3 study topics, and the proportion of the number of the articles on the top-3 topics and that of the number of citations was 47% and 47.7%, respectively. Moreover, 20 (90.9%) of the 22 high-quality articles published in journals with high IF > 9 were the research of top-3 topics. Besides, the most contributing author, Hong WK (n = 11), was from the most contributing institution and country of origin, M.D. Anderson Cancer Center (n = 12), United States (n = 41). Systematic reviews (n = 7), randomized controlled trial (n = 5), cohort studies (n = 18) were study designs with higher evidence level, but the large majority (n = 70) were considered lower level.
The results of this first citation analysis of the 100 most-cited articles on OPMD provide a historical perspective and key topics, and suggest a troika for the trends of further research and clinical practice in the field of OPMD.
Causal inference and directed acyclic graph: An epidemiological concept much needed for oral submucous fibrosis
2020, Journal of Oral Biology and Craniofacial Research
Citation Excerpt :
Although occasionally preceded by, or associated with, the formation of vesicles, it is always associated with a juxta-epithelial inflammatory reaction followed by a fibroelastic change of the lamina propria and epithelial atrophy that leads to stiffness of the oral mucosa and causes trismus and an inability to eat’.1–3 Since 1962, various nomenclatures have been proposed in the scientific literature including Juxta-epithelial fibrosis, Idiopathic palatal fibrosis, Idiopathic scleroderma of mouth, Diffuse oral submucous fibrosis, Sclerosing stomatitis, and Oral fibrosis.4 Since the disorder is most commonly diagnosed as a clinical entity with a wide range of presentation of symptoms including pain, burning sensations, ulcerations, progressive restriction in mouth opening, blanching of the mucosa, depapillation of the tongue, loss of pigmentation and dysphonia, and hearing impairment in advanced cases (Fig. 1),6–9 recently, a clinical definition was proposed describing OSMF as ‘a debilitating, progressive, irreversible collagen metabolic disorder induced by chronic chewing of areca nut and its commercial preparations; affecting the oral mucosa and occasionally the pharynx and esophagus; leading to mucosal stiffness and functional morbidity; and has a potential risk of malignant transformation’.5
Oral submucous fibrosis (OSMF), although already established as an oral potentially malignant disorder (OPMD), still stands over a weak bridge because of its controversial pathogenesis. There has been tremendous work on this disease since 1962, surprisingly, we are unsuccessful in finding the exact causation of OSMF. The potential cause for this is either a lack of systematically performed clinical observational studies or over-interpreted inferences of the presented results. Accordingly, the literature is piled with complex data that is being followed by emerging researchers. Hence, this conceptual paper is presented to focus and explain only the epidemiological concepts of causal inference and the construction of DAGs. These concepts will help to encode our subject matter knowledge and assumptions regarding the causal structure problem, classify the source of systematic bias, identify the potential confounders, potential issues in the study design, and guide the data analysis.
Nano-drug delivery system targeting FAP for the combined treatment of oral leukoplakia
2024, Drug Delivery and Translational Research
Oral erythroplakia and oral erythroplakia-like oral squamous cell carcinoma – what’s the difference?
2023, BMC Oral Health
Nanodrug delivery system targeting FAP for the combined treatment of oral leukoplakia
2023, Research Square
Potentiated action on the progression of OSMF by hypoxia mediated signaling pathway by the epithelial mesenchymal transition and angiogenic apparatus
2023, Journal of Cancer Research and Therapeutics

View all citing articles on Scopus

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Oral and Maxillofacial PathologyHistorical perspective and nomenclature of potentially malignant or potentially premalignant oral epithelial lesions with emphasis on leukoplakia—some suggestions for modifications

Section snippets

Definition

Preleukoplakia

Keratoses

Discussion and Some Suggestions for Modifications of the Definition of Leukoplakia and the Clinical Classification

J Am Dent Assoc

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

Int J Oral Surg

J Am Dent Assoc

J Am Acad Dermatol

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol

Oral Oncol

Oral Oncol

Oral Oncol

Die idiopathischen Schleimhautplaques der Mundhöhle (Leukoplakia buccalis)

Arch Derm Syphilol

Report from a Meeting on Investigators on the Histological Definition of Precancerous Lesions

Oral and Maxillofacial Pathology
Historical perspective and nomenclature of potentially malignant or potentially premalignant oral epithelial lesions with emphasis on leukoplakia—some suggestions for modifications