ABSTRACT
Lichen sclerosus is a chronic inflammatory mucocutaneous disease, rarely involving the mouth. There are only 20 well-documented cases of oral lichen sclerosus reported in the English-language literature. This report describes the clinicopathological features of 6 cases of oral lichen sclerosus; 5 in women. There were 12 lesions, mainly on the lips (50%) and buccal mucosa (25%). The affected areas appeared as irregular whitish patches, harder than the surrounding tissue. Half of the patients were symptomatic and presented with no associated skin and/or genital lesions. All cases were biopsied, and histopathological features were evaluated using hematoxylin-eosin and Verhoeff's stains, S-100 immunohistochemical reaction and transmission electron microscopy. Management of the oral lesions consisted of surgical excision, intralesional triamcinolone acetonide, oral colchicine, and regular follow-up. There is no effective curative treatment, but there are some options for patient management; and colchicine may be considered an additional choice.
Subject(s)
Lichen Sclerosus et Atrophicus/pathology , Mouth Diseases/pathology , Administration, Oral , Adolescent , Adult , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Biopsy , Child , Colchicine/administration & dosage , Colchicine/therapeutic use , Diagnosis, Differential , Female , Follow-Up Studies , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Immunohistochemistry , Injections, Intralesional , Lichen Sclerosus et Atrophicus/drug therapy , Lichen Sclerosus et Atrophicus/surgery , Lip Diseases/drug therapy , Lip Diseases/pathology , Lip Diseases/surgery , Male , Microscopy, Electron, Transmission , Mouth Diseases/drug therapy , Mouth Diseases/surgery , Mouth Mucosa/pathology , Retrospective Studies , S100 Proteins/analysis , Tongue Diseases/drug therapy , Tongue Diseases/pathology , Tongue Diseases/surgery , Treatment Outcome , Triamcinolone Acetonide/administration & dosage , Triamcinolone Acetonide/therapeutic use , Young AdultABSTRACT
Squamous cell carcinoma (SCC) of the oral cavity is a multistep process, progressing through a series of discrete, irreversible and complementary alterations in genes that control cell growth, death, and differentiation. In the premalignant state, the oral mucosa progresses through various grades of epithelial dysplasia, with the potential to convert to SCC. Natural and synthetic vitamin A metabolites and analogs (retinoids) were found to suppress head and neck and lung carcinogenesis in animal models, and inhibit carcinogenesis in individuals with premalignant lesions and a high risk to develop cancer of the aerodigestive tract. Likewise, retinoids prevent the development of second primary cancers in head and neck and lung cancer patients who had been treated for the first primary. These effects are thought to result from changes in the expression of genes that regulate cell growth and differentiation. Chemopreventive strategies are designed to suppress, reverse, or prevent the formation of premalignant lesions and their subsequent progression to SCC. This is a review of the application of retinoids in the chemoprevention of head and neck cancer.
