Er,Cr:YSGG laser therapy for oral leukoplakia minimizes thermal artifacts on surgical margins: a pilot study.

Laser use for biopsy of suspicious lesions may simulate cytological atypia at the margin of the incisions, challenging pathological diagnosis. Erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser has shown promising results in experimental models by inducing fewer artifacts. The aims of this study were to examine the thermal wounds induced by Er,Cr:YSGG laser in a short series of oral leukoplakias in terms of cytological and epithelial architectural changes and also to assess the width of the thermal damage lateral to the incision. Four oral leukoplakia patients entered the study and underwent complete surgical excision of their lesions by using Er,Cr:YSGG laser. Patients were weekly controlled until complete healing was accomplished. The patients were included on the existing follow-up program for these lesions thereafter. Study samples were routinely processed by the same technician and double-blindedly studied by two pathologists until a consensus was reached for each case. The pathological analysis of the samples revealed no autolysis and no fixation- or handling-related artifacts. However, cellular and nuclear polymorphism could be observed in two samples. Loss of intercellular adherence was the most frequent thermal artifact in this series; all pseudodysplastic artifacts recognized in the study were of low intensity and located at the basal and suprabasal layers of the leukoplakias' epithelium. The width of the thermal damage at the edge of the incision scored an average of 26.60 ± 25.3 µm. It is concluded that irradiation with Er,Cr:YSGG laser induces a minimal amount of thermal artifacts at the surgical margins of oral leukoplakias and avoids diagnostic interferences with real dysplastic borders.

Oral cancer awareness at chemist's and herbalist's shops: new targets for educational interventions to prevent diagnostic delay.

OBJECTIVES: To assess whether chemist's and herbalist's shops were offering appropriate advice for patients seeking guidance on a potentially malignant oral lesion. MATERIAL AND METHODS: A cross-sectional study was undertaken using the standardised patient approach on a representative sample of chemist's and herbalists' shops in Galicia (Spain). The introductory statement was "I have a painful ulceration on the tongue for about a month now. What would you advise?" The study sample was selected by stratified random sampling for a 5% precision, and contacted by telephone. To disclose a hypothetical bias in telephone answers, another study was designed for two provinces where pharmacies were visited in one province and herbal shops in the other one. RESULTS: A total of 460 establishments out of 1534 were contacted: 306 pharmacies (66.5%) and 154 herbalist's shops (33.5%). Patients were adequately referred from pharmacies significantly more frequently than were from herbalist's shops, which mostly prescribe over-the-counter (OTC) remedies (86.4%). Community pharmacy assistants resulted more likely to recommend OTC remedies (55.6% vs. 13%) and significantly less likely to refer patients to a dentist or physician than pharmacists. The most frequent OTC offered at chemists' were mouthwashes, while herbalist's shops prescribed propoleum (50%) and tea tree (Melaleuca alternifolia) preparations (23.8%). CONCLUSION: New off-clinical counsellors (herbalists and pharmacy assistants) have been identified as potential creators of patient diagnostic delay in oral cancer, as well as the need for increasing oral cancer awareness amongst community pharmacists. Educational strategies to improve advice and referral should be designed for these collectives.