Proliferative verrucous leukoplakia: diagnosis, management and current advances / Leucoplasia verrucosa proliferativa: diagnóstico, conduta e avanços atuais

Abstract Introduction: Proliferative verrucous leukoplakia is a multifocal and progressive lesion of the oral mucosa, with unknown etiology, and commonly resistant to all therapy attempts with frequent recurrences. It is characterized by a high rate of oral squamous cell carcinoma and verrucou carcinoma transformations. Objective: To analyze the studies about Proliferative verrucous leukoplakia and develop a concise update. Methods: A Pubmed search identifying studies (laboratory research, case series and reviews of literature) that examined patients with Proliferative verrucous leukoplakia was realized. Results: There are not enough studies about Proliferative verrucous leukoplakia in the literature. The few found studies not present a consensus about its etiology and diagnosis criteria. Although several treatment strategies have been proposed, most of them still show a high recurrence rate. Conclusion: More research about Proliferative verrucous leukoplakia is necessary to understand and treat this disease.

Resumo Introdução: Leucoplasia verrucosa proliferativa (LVP) é uma lesão multifocal e progressiva da mucosa oral, com etiologia desconhecida e comumente resistente a todas as tentativas terapêuticas, com recorrências frequentes. É caracterizada por uma alta taxa de transformação em carcinoma de células escamosas e carcinoma verrucoso da cavidade oral. Objetivo: Analisar os estudos sobre LVP e elaborar uma atualização resumida. Método: Foi realizada uma pesquisa na base de dados Pubmed que identificou estudos (pesquisas laboratoriais, séries de casos e revisões de literatura) que avaliaram pacientes com LVP. Resultados e discussão: Não há estudos suficientes sobre LVP na literatura. Os poucos estudos encontrados não apresentam consenso quanto aos critérios de etiologia e diagnóstico. Embora várias estratégias de tratamento tenham sido propostas, a maioria ainda apresenta alta taxa de recorrência. Conclusão: Mais pesquisas sobre LVP são necessárias para entender e tratar essa doença.

Proliferative Veruccous Leukoplakia: An Extensive Red and White Lesion.

Proliferative verrucous leukoplakia (PVL) is a rare form of leukoplakia, which was first described by Hansen et al. in the year 1985. PVL is a disease with aggressive behavior due to its high rate of recurrence and a high rate of malignant transformation, usually more than 70%. This is a long-term progressive condition, which is observed more frequently in females over the age of 60 years. In the course of time, PVL tends to become multifocal with progressive deterioration of the lesions, making it more and more difficult to control. Unlike other cases of leukoplakia, tobacco use does not seem to have a significant influence on the appearance and progression of PVL. As this condition is seen in non-smokers, the etiology of PVL remains unclear making the management and diagnosis difficult. The aim of this article is to present a case which is diagnosed based on the diagnostic criteria proposed by Cerero-Lapiadra et al.

Avaliação clínica e histopatológica e hábitos associados ao surgimento de leucoplasias e eritroplasias orais / Clinical and histopathological evaluation and habits associated with the onset of oral leukoplakia and erythroplakia

Objective: This research aims to establish the prevalence, factors associated with the onset, and clinical and histopathological features of oral leukoplakia and erythroplakia, so that these data can contribute to the prevention of these lesions and, consequently, of oral cancer. Material and method: A retrospective study was conducted at a reference service of Universidade Federal do Rio Grande do Norte (UFRN) from 2000 to 2012. To verify the association of variables, Pearson's chi-squared test and Fisher's exact test (p ≤ 0.05) were used. Results: Among 6,560 investigated records, 54 cases were selected, of which 44.4% were male and 55.6% female, with mean age of 56.93 years. Regarding habits, 72.2% were smokers and 25% were alcohol users; 17.9% showed association of both habits. Oral leukoplakia lesions were the most prevalent (0.65%) and oral erythroplakia showed greater association with malignancy in the histopathological presentation (p = 0.001). Most lesions showed no symptoms (p = 0.004). The most frequent was oral leukoplakia in smoking women, with mean age of 57 years. Conclusion: Knowledge of associated factors and clinical characteristics of oral leukoplakia and erythroplakia is essential for establishing the correct diagnosis and treatment...

Objetivo: Esta pesquisa objetiva estabelecer a prevalência, os fatores associados ao surgimento e as características clínicas e histopatológicas das leucoplasias e eritroplasias orais, a fim de que estes dados possam contribuir na estratégia de prevenção ao desenvolvimento dessas lesões e, consequentemente, do câncer oral. Material e método: Foi realizado estudo retrospectivo em um serviço de referência da Universidade Federal do Rio Grande do Norte (UFRN) no período de 2000 a 2012. Para verificar a associação das variáveis foi utilizado o teste qui-quadrado e o exato de Fisher (p ≤ 0,05). Resultados: Foram investigados 6.560 prontuários, tendo sido selecionados 54 casos, dos quais 44,4% do sexo masculino e 55,6% do feminino, com idade média de 56,93 anos. Com relação aos hábitos, 72,2% eram fumantes e 25% usuários de álcool, sendo que 17,9% exibiam associação dos dois hábitos. As leucoplasias orais foram as lesões mais prevalentes (0,65%), e as eritroplasias orais apresentaram maior associação com apresentação maligna no diagnóstico histopatológico (p = 0,001). A maioria das lesões não apresentou sintomatologia (p = 0,004). A leucoplasia oral foi mais frequente em mulheres fumantes com média de idade de 57 anos. Conclusão: O conhecimento dos fatores associados e das características clínicas das eritroplasias e leucoplasias orais é essencial para o estabelecimento do correto diagnóstico e tratamento...

Leucoplasia bucal: levantamento epidemiológico dos casos encontrados no Serviço de Diagnóstico Histopatológico do Instituto de Ciências Biológicas da Universidade de Passo Fundo / Oral leukoplakia: epidemiological survey of cases found at the Histopathologic Diagnosis Service of the Institute of Biological Sciences, University of Passo Fundo

Objetivo: O presente estudo teve como objetivo realizar um estudo epidemiológico observacional transversal dos casos de leucoplasia bucal registrados no Serviço de Diagnóstico Histopatológico do Instituto de Ciências Biológicas (ICB) da Universidade de Passo Fundo (UPF).Materiais e Métodos: Foram considerados os casos diagnosticados como “leucoplasia bucal” entre os anos de 1989 e 2011. Os dados que dizem respeito à idade, sexo eraça dos pacientes, bem como os dados de localização da enfermidade na cavidade bucal foram obtidos das requisições de exame histopatológico de cada paciente. Foram observados a presença de hábitos deletérios nos pacientes acometidos e as características clínicas das lesões levantadas. Os dados coletados foram analisados por meio de estatística descritiva de frequência e expressos em tabelas e/ou gráficos, a fim de serem confrontados com os dados da literatura. Resultados e conclusão: Pôde-se inferir que a época da vida mais afetada pela leucoplasia foi a 7ª década da vida, a cor branca foi predominante, o sexo masculino o mais afetado e a região mais acometida foi a mucosa jugal na linha de oclusão. Exposição solar, trauma e fumo foram as principais causas encontradas no estudo, porém houve muitos laudos incompletos, o que leva à dúvida quanto aos demais casos (a maior parte neste estudo). O tempo de evolução das lesões foi relativamente rápido, a maioria aparecendo de 0-6 meses em boca, e normalmente assintomáticas. A coloração branca, sem presença de displasia, foi predominante e as características das lesões se assemelharam em todos os casos.

Objective: This study aimed to conduct a transversal observational epidemiological study in reported cases of oral leukoplakia in the Department of Diagnostic Histopathology of the Institute of Biological Sciences (ICB), University of Passo Fundo (UPF). Materials and Methods: We considered the cases that were diagnosed as “oral leukoplakia” between the years 1989 and 2011. The data pertaining to age, sex and race of patients, as well as the location data of the disease in the oral cavity were obtained from histopathological examination of requests for each patient. We observed the presence of harmful habits in affected patients and the clinical features of raised lesions. The collected data were analyzed using descriptive statistics and expressed as frequency tables and/or graphics in order to be compared with data found in literature. Results and conclusion: It might be inferred that the period of life most affected by leukoplakia was the 7th decade of life, was predominantly white, male sex the most affected and most affected region was the buccal mucosa in the line of occlusion. Sun exposure, smoking and trauma were the main causes in the study, but there were many reports are incomplete, which leads to doubt as to the other cases (most of this study). The time evolution of the lesions was relatively quick, most appearing tomouth from 0-6 months, and usually asymptomatic. The white color, without the presence of dysplasia was predominant and lesion characteristics were similar in all cases.

Association between polymorphisms at N-acetyltransferase 1 (NAT1) & risk of oral leukoplakia & cancer.

Background & objectives: N-acetyltransferases 1 and 2 (NAT1 and NAT2) are important enzymes for metabolism of tobacco carcinogens. Due to polymorphisms, improper activities of these enzymes might lead to the formation of DNA adducts that may modulate risk of tobacco related oral precancer and cancer. Previously, it was shown that NAT2 polymorphisms did not modulate the risk of oral precancer and cancer. We undertook this study to check whether polymorphisms at NAT1 can modulate the risk of oral leukoplakia and cancer either alone or in combination with NAT2. Methods: Genotypes at four SNPs on NAT1 were determined by TaqMan method in 389 controls, 224 leukoplakia and 310 cancer patients. Genotype data were analyzed to know haplotypes and acetylation status of individuals and, then to estimate the risk of diseases. Using our previously published NAT2 data, combination of NAT1 and NAT2 acetylation genotypes of patients and controls were also analyzed to estimate the risk of diseases. Results: Analysis of NAT1 genotype data revealed that 1088T and 1095C alleles exist in strong linkage disequilibrium (r2=0.97, P<0.0001) and SNPs are in Hardy-Weinberg Equilibrium (P=0.1). Wild type or normal acetylating and variant or rapid acetylating alleles were two major alleles (frequencies 0.62 and 0.36, respectively) present in the control population. NAT1 rapid acetylation could not modulate the risk of leukoplakia and cancer (OR=0.9, 95% CI: 0.6-1.3; OR=1.0, 95% CI: 0.7-1.4, respectively). Analysis of combined NAT1 and NAT2 acetylating data also showed no significant enhancement of the risk of diseases. Interpretation & conclusions: NAT1 rapid acetylation alone as well as combination of NAT1 rapid-NAT2 slow acetylation did not modulate the risk of oral precancer and cancer in our patient population. So, NAT1/NAT2 metabolized carcinogen products may not be involved in tobacco related oral precancer and cancer. It may be interpreted that large sample size as well as combination of polymorphisms at other candidate loci may be important to estimate the risk of a complex disease like oral cancer.

Oral changes associated with tobacco and opioids consumption in patients referred to Zahedan Dental School

Smoking leads to several oral complications and it is a predisposing factor for oral cancer. The aim of this study was to assess the oral changes related to consumption of tobacco and opioids in patients attending the Oral Medicine Center at Zahedan Dental School. This was a cross-sectional study performed based on simple sampling. A total of 211 tobacco and opioids smoker persons attending the Oral Medicine Department at Zahedan Dental School were examined during February to May 2006. Data were collected using a questionnaire. Statistical tests including the chi-square and variance tests were used for analysis of data. Of 211 persons, 186 were males and 25 females with a mean age of 38.5 +/- 7.6 years. The overall prevalence of oral changes was 98.5% and the prevalence of every single change in oral cavity was 3.3% [leukoedema]; 30.8% [pigmentation]; 21.7% [leukoedema and pigmentation]; 43.3% [leukoedema, pigmentation and hyperkeratosis]; 0.9% [leukoedema-pigmentation, and tobacco pouch]. The prevalence of oral changes in men was higher than in women [p<0.05]. Cigarette smoking in men and hookah in females were common. The most common oral change was pigmentation. Oral changes were more common in men than in women, and the smoking pattern showed difference between men and women. The most frequent material consumed was cigarette in men and hookah in women

The prevalence of oral mucosal lesions in alcohol misusers in Chennai, south India.

AIMS AND OBJECTIVES: This study was conducted to assess the prevalence of various oral mucosal lesions (OML) among alcohol misusers attending a rehabilitation center in Chennai, south India. MATERIALS AND METHODS: Qualified dental surgeons examined 500 consecutive alcohol misusers at Ragas Dental College and Hospital and TTK Hospital, India. Thorough history and oral findings were recorded in a pre-determined format. Data entry and statistical analysis were done using SPSS 10.0.5beta. The variables for this study were OML, Oral Hygiene Index (OHI), age, smoking, and alcohol misuse (type and units consumed and duration of misuse). RESULTS: Of the 500 patients, 77% were in the 25-44 years old age group and 84% were married. The mean age of initiation of alcohol misuse was 34 years. In addition to alcohol, 72% smoked tobacco and 96% used other psychoactive substances. The mean alcohol use duration was 12.6 years. A total of 25% of the study group had at least one OML. The common oral lesions were smoker's melanosis (10.2%), oral submucous fibrosis (8%), and leukoplakia (7.4%). Those who misused spirits had a higher incidence of OML than those who misused beer or both. Patients with fair oral hygiene had an odds ratio (OR) of 2.96 for OML compared with an OR of 2.08 for those who had OML with good oral hygiene. CONCLUSION: This study indicates that subjects who misuse alcohol have poor oral hygiene and are at risk for the development of periodontal disease and OML. This survey indicates that oral examination and treatment should be a part of the standard care for alcohol misusers at rehabilitation centers.

Leucoplasia: uma revisão de literatura / Leukoplakia: a literature revision

O objetivo do presente trabalho é discorrer e apresentar um relato de caso sobre a leucoplasia, uma lesão predominantemente branca, de etiologia desconhecida e que tem amplo poder de malignização. Além disso, apresenta uma alta prevalência, principalmente na população mais idosa e que apresenta hábito de fumar. O diagnóstico da lesão, por ser assintomática, muitas vezes acontece num exame clínico de rotina. O tratamento, entre outros, constitui-se da excisão cirúrgica, oferecendo a possibilidade de posterior análise histopatológica.

Kindler syndrome.

Kindler syndrome is a rare autosomal recessive disorder associated with skin fragility. It is characterized by blistering in infancy, photosensitivity and progressive poikiloderma. The syndrome involves the skin and mucous membrane with radiological changes. The genetic defect has been identified on the short arm of chromosome 20. This report describes an 18-year-old patient with classical features like blistering and photosensitivity in childhood and the subsequent development of poikiloderma. The differential diagnosis of Kindler syndrome includes diseases like Bloom syndrome, Cockayne syndrome, dyskeratosis congenita, epidermolysis bullosa, Rothmund-Thomson syndrome and xeroderma pigmentosum. Our patient had classical cutaneous features of Kindler syndrome with phimosis as a complication.

Factores de riesgo de lesiones premalignas y malignas bucales / Risk factors of premalignant and malignant oral injuries

Se realizó un estudio sobre los principales factores de riesgo asociados con la aparición de lesiones malignas y premalignas bucales en nuestra área de salud con el propósito de encaminar el trabajo preventivo y para educar a nuestra población. Se encontró que el 67,7por ciento de los pacientes encuestados presentaron algún factor de riesgo asociado con la aparición de estas lesiones y el 4,8 por ciento presentó algún tipo de lesión. El sexo masculino fue el más afectado, y el uso de prótesis y el hábito de fumar los factores de riesgos más frecuentes. La leucoplasia constituyó la lesión más encontrada, con el 36,7 por ciento y las localizaciones más frecuentes la mucosa del carrillo y el labio inferior(AU)

A study on the main risk factors associated with the appearance of malignant and premalignant oral lesions in our health area was conducted aimed at directing our preventive work and at educating our population. It was found that 67.7 percent of the surveyed patients presented some risk factor associated with the appearance of these lesions and 4.8 percent had some type of lesion. Males were the most affected and the denture wearing and the smoking habit were the most frequent risk factors. Leucoplakia was the most common lesion, accounting for 36.7 percent. The cheek mucosa and the lower lip were the most frequent localizations(AU)

Considerações gerais e abordagem clínica da leucoplasia oral / General considerations and clinical aproach of oral leukoplakia

A leucoplasia constitui a lesão cancerizável mais freqüente na mucosa bucal e é definida pela Organização Mundial da Saúde como uma mancha ou placa branca, que não pode ser classificada, por seus aspectos clínicos, como qualquer outra lesão. Seu potencial de transformação maligna, associado à alta prevalência, exige do cirurgião-dentista conhecimentos básicos, que permitam o correto diagnóstico e uma abordagem clínica adequada. Os autores fazem uma revisão da literatura enfocando aspectos gerais sobre a etiologia, as características clínicas e histopatológicas e os aspectos epidemiológicos da leucoplasia oral. Há evidências de que a etiologia da lesão está associada a alterações genéticas herdadas e adquiridas, assim como ocorre na oncogênese. Por outro lado, o risco de malignização da leucoplasia requer intervenção terapêutica adequada que inclui o abandono do álcool e do tabaco, bem como o controle clínico periódico do paciente, mesmo após a excisão cirúrgica da lesão, em função da possibilidade de recidivas

A simple risk estimates study for oral cavity cancer: practical approach in Indian context.

A study was conducted on 131 cases of oral cavity cancer (OCC), 145 cases of oral leucoplakia and 704 subjects without any oral lesions to investigate risk factors associated with the development of carcinoma of oral cavity in a hospital based cancer registry. Personal interviews, as well as physical examinations of the subjects enabled evaluation of a variety of potential risk factors. Potential risk factors like tobacco chewing, tobacco smoking, snuff dipping, alcohol consumption, bad oral and dental hygiene and age were given each certain numerical values. Each subject was first given a scoring and then analysed and correlated with the presenting lesions, when present. The study revealed that tobacco chewing and bad oral and dental hygiene contributed mainly to higher scoring. Among the subjects in high risk group (scoring more than 400) 63% had OCC, 21% had oral leucoplakia and 16% had no clinical oral lesions. Among the medium risk group (scoring between 100 and 400) 6% had OCC, 21% had leucoplakia and 73% had no oral lesions. In low risk group (scoring below 100) 8% had leucoplakia and 92% had no clinical oral lesions. Using the scoring system, it is suggested that the high risk group for OCC could be identified from general population and cancer detection tests could be specially directed towards this target group to detect maximum number of cases with minimum possible resources.

Crioterapia em lesöes leucoplásticas da boca: estudo clínico em humanos / Cryotherapy in leukoplakia lesions on bucal mucosa: clinic study in human

Este estudo tem como objetivo avaliar clinicamente o efeito terapêutico e sintomático da crioterapia com nitrogênio líquido em lesöes leucoplásticas da mucosa bucal. Para a realizaçäo deste trabalho foram selecionados 24 pacientes, triados no Centro de Oncologia Bucal, que apresentavam lesäo com características clínicas de leucoplasia. A idade, o sexo e a raça näo foram levados em consideraçäo e todos foram tratados com o nitrogênio líquido na forma spray. O aparelho utilizado para a aplicaçäo foi uma garrafa térmica e um cano de cobre com uma agulha de uso veterinário. As avaliaçöes foram feitas aos 3, 7, 15, 30, 40 e 60 dias pós-operatórios. Com base neste estudo, concluiu-se que o criospray é um método assintomático e eficaz para este tratamento

Leucoplasia: revisäo de literatura e apresentaçäo de um caso clínico / Leucoplakia: rewiew of the literature and report of a case

Leucoplasia é um termo clínico que refere-se a uma alteraçäo localizada nas mucosas, com aspecto de placa ou mancha esbranquiçada firmemente aderida, que näo pode ser removida por raspagem e que näo pertence a qualquer outro tipo de doença. Säo consideradas lesöes cancerizáveis devido ao aumento no risco de transformaçäo maligna. Neste caso, em torno de 4 a 6 porcento das lesöes evoluem para o câncer. Portanto, é necessário que se estabeleça um diagnóstico correto precocemente e que institua-se um tratamento adequado para alcançar-se resultados satisfatórios, sendo de extrema importância o controle periódicos dos pacientes que apresentam este tipo de lesäo. O objetivo deste trabalho é o de abordar os possíveis agentes etiológicos, os aspectos clínicos e histopatológicos, bem como o tratamento e o prognóstico deste tipo de lesäo, através de uma revisäo da literatura, ilustrando-se com a exposiçäo de um caso clínico

Qual a importância do exame bucal na psoríase? / Which is the importance of a full oral examination in psoriasis?

Os autores discutem a necessidade da avaliaçäo bucal em pacientes psoriásicos, bem como apresentam uma revisäo da literatura concernente às lesöes bucais específicas da psoríase e à associaçäo da mesma com a língua geogrífica, língua fissurada e estomatite geográfica. Os autores concluem que a língua geográfica pode ser uma forma frusta da psoríase, ressaltando a importância do exame estomatológico e a pesquisa de antecedentes familiares para língua geográfica, em psoriásicos

Leucoplasia: evaluación clínico patológico de una entidad premaligna / Leukoplasia: clinico pathology evaluation of the premalignan entity

El presente estudio hace una recopilación y revisión bibliografica de la leucoplasia bucal como lesión premaligna. Se analizan factores etiológicos, histológicos, tratamiento y diagnóstico, además se hace un estudio somero de la leucoplasia velluda por estar asociada al SIDA