Oral erythroplakia and oral erythroplakia-like oral squamous cell carcinoma - what's the difference?

BACKGROUND: Oral erythroplakia (OE) is a rare oral potentially malignant disorder, that has a high rate of malignant transformation. The definition of OE still lacks uniformity. In particular, lesions that look clinically like erythroplakias, but are histopathologically diagnosed as squamous cell carcinomas are still sometimes called erythroplakias. The purpose of this study is to present demographic and clinicopathologic features of a series of OEs and clinically oral erythroplakia -like squamous cell carcinomas (OELSCC), to study their differences and to discuss the definition of OE. METHODS: A multicenter retrospective case series of OEs and OELSCCs. Descriptive statistics were used to analyze the data. RESULTS: 11 cases of OEs and 9 cases of OELSCCs were identified. The mean age of the OE patients was 71 years and 72.7% were female, while the mean age of the OELSCC patients was 69 years, and all were female. 9% of the OE and 22% of the OELSCC patients had smoked or were current smokers. 72.7% of the OEs and 55.5% of OELSCCs were uniformly red lesions. 63.6% of the OE and 22% of the OELSCC patients had a previous diagnosis of oral lichenoid disease (OLD). The malignant transformation rate of OE was 9% in a mean of 73 months. CONCLUSIONS: OE and OELSCC may arise de novo or in association with OLD. Tobacco and alcohol use were not prevalent in the present cases. The clinical features of OEs and OELSCC are similar, but symptoms, uneven surface and ulceration may be more common in OELSCCs than in OEs. Clinical recognition of OE is important since it may mimic other, more innocuous red lesions of the oral mucosa. The diagnosis of OE requires biopsy and preferably an excision. Clarification of the definition of OE would aid in clinical diagnostics.

Treating erythroplasia of Queyrat with photodynamic therapy following circumcision and dermabrasion.

We describe a case of a patient with erythroplasia of Queyrat located on the whole glans and end of the prepuce that was successfully treated with three courses of photodynamic therapy after the completion of circumcision and dermabrasion. Skin lesions disappeared after receiving this combination of treatments and have not recurred during the past 6 months of follow-up.

The White Lesion, Hyperkeratosis, and Dysplasia.

Laryngeal mucosal precursor lesions represent a challenging clinical entity. Updated classification systems allow for grade-based categorization. Multiple management options exist, with treatment decisions made jointly by physician and patient and focused on both appropriate lesion treatment and preservation of laryngeal structure and function. Traditional methods include cold steel and CO2 laser excision, with newer modalities using angiolytic lasers for lesion ablation. Both operating room-based and office-based treatment options exist, and there are advantages and disadvantages to each approach. Research is ongoing to advance the understanding of lesion biology, and to optimize prevention and treatment.

Outcome of excision of oral erythroplakia.

Oral erythroplakia is a precancerous lesion with high malignant potential, and resection is the recommended treatment. We designed a retrospective study to analyse the outcome of treatment in patients who had operations for oral erythroplakia. A total of 84 patients (74 men and 10 women, mean (SD) age 54 (12) years, range 29-83) were enrolled. Histopathologically the diagnoses were invasive carcinoma (n=3), dysplasia/carcinoma in situ (n=61), and squamous hyperplasia (n=20), and all patients were treated by carbon dioxide laser excision. There was no postoperative malignant transformation, but invasive carcinoma found after initial excision (n=3) was treated by further radical excision. The mean (SD) follow-up period was 46 (29) months (range 1-124), The postoperative recurrent rate was 14/84 (16.7%). The area of oral erythroplakia was the only factor associated with postoperative recurrence on univariate analysis, and was also the only independent factor that predicted postoperative recurrence in multivariate logistic regression analysis. An area exceeding 80 mm2 had the best predictive value (sensitivity=0.71, specificity=0.67) with a 5.1 times increased risk (odds ratio=5.1, CI 95% 1.45 to 18.05, p=0.01) of recurrence. Laser excision is effective for oral erythroplakia that is still confined to dysplasia of any degree, with low morbidity. The area of oral erythroplakia is a predictive factor for postoperative recurrence.

[Precancerous conditions in the ENT area]. / Prekancerózy v ORL oblasti.

An important part of tumor prevention is early detection, dia-gnosis, treatment and screening of precancerous conditions. Correct detection and screening of premalignant lesions leads to early dia-gnosis of a malignant process which provides a better chance to completely cure the patient and also predicts better quality of life. Precancerous conditions look like whitish, red or mixed mucose lesions (leukoplakia, erytroplakia, erytroleukoplakia) which are visible during clinical examination. Nevertheless, these mucose changes are not absolutely conclusive. Therefore, histological testing is necessary for dia-gnosis and determination of bio-logical potencial of precancerous lesions. Precancerous lesions as a term of histological terminology means dysplasia. The risk of progression of dysplasia into a carcinoma depends on a grade of dysplasia. The conservative or surgical treatment is chosen according to localisation and grade of dysplasia.

Use of narrow band imaging guidance in the management of oral erythroplakia.

Erythroplakia is an epithelial lesion that holds the highest risk of showing severe dysplasia or microinvasive carcinoma. The gold standard treatment is total excision to obtain a complete histopathological diagnosis. Traditionally this has been done by illumination of the lesion with white light, and resection with adequate margins. The difficulty with erythroplakia is that margins can be hard to delineate precisely, and even severe dysplasia can be seen with only subtle changes in the surface mucosa. Narrow band imaging is a novel technique that enhances the diagnostic potential of endoscopy. It highlights abnormalities in the superficial vasculature, which means that lesions such as oral erythroplakia can be identified more easily. We report its use in the identification of the full extent of lesions, and show its intraoperative advantages in obtaining resection margins free from disease.

Potentially malignant disorders of the oral and oropharyngeal mucosa; present concepts of management.

In spite of tremendous progress in the field of molecular biology there is yet no single marker that reliably predicts malignant transformation of a potentially malignant disorder of the oral mucosa. Therefore, it is recommended to excise or laser any oral of oropharyngeal leukoplakia/erythroplakia, if feasible, irrespective of the presence or absence of dysplasia. However, it is actually unknown whether such removal truly prevents the possible development of a squamous cell carcinoma. Therefore, lifelong follow-up is recommended at intervals of no more than 6 months. At present, oral lichen planus is more or less accepted as being a potentially malignant disorder. There are no means to prevent such event. The efficacy of follow-up of oral lichen planus is questionable.

The effect of quitting smoking on the risk of unfavorable events after surgical treatment of oral potentially malignant lesions.

The aim of this study was to examine if cessation of smoking after surgical excision of oral potentially malignant lesions in smokers reduced the risk of recurrences, development of new lesions or malignancies. 51 patients with oral leukoplakia or erythroplakia were included. They were daily smokers at the time of diagnosis and were treated surgically. Patients were advised to quit smoking at each visit. The change of smoking habits and occurrence of unfavorable events were noted during follow-up. Descriptive statistics, Fischer's exact test, Kaplan-Meier curves with log-rank test, and Cox proportional hazards model were used for analysis. 16 patients (31%) quit smoking during the observation period. Only one quitter (6%) developed recurrence compared with 11 continuing smokers (33%) (p<0.05). There were no new lesions and no malignancies among quitters compared with 8 new lesions (p<0.05) and 5 carcinomas (p>0.05) in continuing smokers. Multivariate analysis showed continuing smoking to be the most significant factor for occurrence of unfavorable events, OR 23.7. In conclusion, cessation of smoking significantly reduced the risk of unfavorable events after surgical treatment of oral potentially malignant lesions in smokers.

Aplicación de la tecnología láser en las lesiones de genitales / Application of laser technology to genital lesions

El empleo del láser en urología ha presentado un avance significativo y en la actualidad es empleado en una gran variedad de patologías. El desarrollo de los diferentes tipos de láser, el empleo de diferentes tipos de longitudes de onda, los sistemas de fibra óptica, la precisión y la reducción del coste han hecho mejorar la tecnología del láser, y extender y potenciar sus indicaciones. Los diversos tipos de láser de los que disponemos en la actualidad, suponen una excelente alternativa terapéutica en el tratamiento de diversas patologías benignas, pre-malignas y malignas localizadas en los genitales, con excelentes resultados estéticos y funcionales, y con una reducida morbilidad. El objetivo de esta trabajo es proporcionar las indicaciones clínicas más importantes y aplicaciones con el láser más novedosas en las lesiones genitales (AU)

The use of laser applications in urology has undergone significant advances and is now used in a wide variety of procedures. Improvements in types of lasers, the wavelength of energy used, optical fiber delivery systems, precision of laser applications and cost reduction have served to further improve laser technology and extend the potential applications. The different types of lasers available at the present time appear to be an alternative treatment modality with excellent cosmetic and functional results and low morbidity in the treatment of benign, pre-malignant and malignant lesions in the genital area. The objective of this article is to provide an update on the most important clinical and experimental advancements therapeutic applications of lasers in genital lesions (AU)

[Oral erythroplakia and erythroleukoplakia: red and red-white dysplastic lesions of the oral mucosa--part 2: cytodiagnosis, pathogenesis, therapy, and prognostic aspects]. / Erythroplakie und Erythroleukoplakie: Rote und rot-weisse Risikoläsionen der Mundhöhlenschleimhaut. Teil 2: Aktuelle Aspekte zur Zytodiagnostik, Pathogenese, Therapie und Prognose.

The second part of the present review article presents and discusses the current literature regarding cytodiagnostic aspects, pathogenesis, therapy, incidence of recurrence, and malignant transformation rate of oral erythroplakia (OE) and oral erythroleukoplakia (OEL). Oral cytopathology, eventually in combination with DNA cytometry, can add valuable information to conventional histopathology, but is not able yet to replace the aforementioned. Numerous molecular genetic variants have been studied in precancerous lesions to gain knowledge about the prognosis of these lesions. Still, there are no evidence-based parameters available to safely detect precursor lesions that will undergo malignant transformation in the future. Excision of OE and OEL should be performed with a margin of safety using the CO2 laser or a scalpel. Data about incidence of recurrence and malignant tranformation rates of OE are mostly based upon case reports or case series. The OEL has a significantly higher risk of malignant transformation than oral leukoplakias.

Oral premalignant lesions: is a biopsy reliable?

PURPOSE: The purpose of the present retrospective study was to learn whether a biopsy of oral premalignant lesions, leukoplakia and erythroplakia, shows histopathological findings representative of the whole surgically removed lesion. Moreover, to see whether histopathological characteristics of the whole lesion are significant for future malignant development after surgery. MATERIALS AND METHODS: A total of 101 lesions in 96 patients were included, 42 lesions (41%) being homogenous and 50 (50%) non-homogenous leukoplakias, whereas nine (9%) were erythroplakias. The lesions were biopsied and subsequently surgically removed on the average of 10.4 months after biopsy. Surgical specimens were examined in two or more step sections distributed throughout the specimen. The histological findings of the biopsies were compared with those of the whole lesions. After surgical intervention the patients were followed (mean 6.8 years, range: 1.5-18.6), and new biopsies taken in case of recurrences. Smokers (73%) were encouraged to quit smoking and candidal infections were treated. The possible influence of different variables on the risk of malignant development was estimated by means of logistic regression analysis. RESULTS: Histological examination of the whole lesions showed that seven lesions (7%) harboured a carcinoma and 70 lesions (69%) showed a degree of epithelial dysplasia or carcinoma in situ. Eleven lesions (12%) developed carcinoma after a mean follow-up period of 7.5 years. A comparison of the degree of dysplasia in the biopsies with that of the whole lesion demonstrated variation with concurrent diagnosis in 49% of the lesions and in 79% after inclusion of lesions with one degree up or down the scale of epithelial dysplasia. CONCLUSION: The estimated odds ratio showed that none of the associated variables including presence of any degree of epithelial dysplasia in the whole lesion, site, demarcation and smoking had influence on the risk of malignant development.

Long-term treatment outcome of oral premalignant lesions.

The purpose of the present retrospective study was to learn the long-term outcome of oral premalignant lesions, leukoplakia and erythroplakia, with or without surgical intervention and to relate the outcome to factors supposed to be significant for malignant development including clinical type, demarcation, size, site, presence of epithelial dysplasia, smoking and surgery. A total of 269 lesions in 236 patients were included. Ninety-four lesions were surgically removed, 39 lesions (41%) being homogenous and 46 (49%) non-homogenous leukoplakias whereas nine (5%) were erythroplakias. Seventy-three percent of the lesions were associated with tobacco habits. The mean size of the lesions was 486 mm(2), and 71% of the lesions showed a degree of epithelial dysplasia. After excision the defects were closed primarily by transposition of mucosal flaps or they were covered by free mucosal or skin grafts. A few defects were left for secondary healing. After surgical treatment the patients were followed (mean 6.8 yrs, range 1.5-18.6 yrs), and new biopsies taken in case of recurrences. One hundred and seventy five lesions had no surgical intervention, 149 lesions (85%) being homogenous and 20 (11%) non-homogenous leukoplakias, and 6 (3%) erythroplakias. Eighty-one percent of the lesions were associated with smoking. The mean size of the lesions was 503 mm(2) and 21 of the lesions (12%) exhibited epithelial dysplasia. Sixty-five lesions were not biopsied. These patients were also followed (mean 5.5 yrs, range 1.1-20.2 yrs), and biopsies taken in case of changes indicative of malignant development. All patients were encouraged to quit smoking and candidal infections were treated. The possible role of different variables for malignant development was estimated by means of logistic regression analysis. Following surgical treatment 11 lesions (12%) developed carcinoma after a mean follow-up period of 7.5 yrs. Non-homogenous leukoplakia accounted for the highest frequency of malignant development, i.e. 20%, whereas 3% of the homogenous leukoplakias developed carcinomas. Surgically treated lesions with slight, moderate, severe and no epithelial dysplasia developed carcinoma with similar frequencies, i.e. 9-11%. Without surgical intervention 16% of the 175 lesions disappeared whereas seven lesions (4%) developed carcinoma after a mean observation period of 6.6 yrs. The highest frequency of malignant development (15%) was seen for non-homogenous leukoplakias, this figure being 3% for homogenous leukoplakias. Fourteen percent of lesions with slight epithelial dysplasia developed malignancy and 2% of lesions with no dysplasia showed malignant transformation. Logistic regression analysis showed a seven times increased risk (OR = 7.0) of non-homogenous leukoplakia for malignant development as compared with homogenous leukoplakia and a 5.4 times increased risk for malignant development for lesions with a size exceeding 200 mm(2). No other examined variables including presence of any degree of epithelial dysplasia, site, demarcation, smoking and surgical intervention were statistically significant factors for malignant development.

Erythroplasia of Queyrat treated with topical methyl aminolevulinate photodynamic therapy.

An 82-year-old man presented with invasive squamous cell carcinoma of the glans penis arising in erythroplasia of Queyrat. He underwent Mohs' micrographic surgery for the invasive carcinoma. Seven weeks later, the residual erythroplasia of Queyrat was treated using photodynamic therapy. Methyl aminolevulinate cream was applied to the glans of the penis under occlusion for 3 hours and then, after local anaesthesia, irradiated with a 630-nm red-light-emitting diode lamp at a dose of 37 J/cm(2) for 8 min. The patient experienced some mild swelling, redness and pain, which subsided over the following 5 days. Eighteen weeks after photodynamic therapy, there had been no recurrence of the lesion, when the patient died from an unrelated cause.

Erythroplasia of Queyrat with urethral involvement: treatment with carbon dioxide laser vaporization.

BACKGROUND: Erythroplasia of Queyrat is an uncommon carcinoma in situ that usually arises on the mucosa of the glans penis or prepuce as red, shiny, sharply demarcated velvety plaques. The treatment is often difficult and associated with significant recurrence rates, especially in cases with urethral involvement. OBJECTIVE: To evaluate carbon dioxide laser treatment in a case of erythroplasia of Queyrat with urethral involvement. MATERIALS AND METHODS: We report a patient with erythroplasia of Queyrat involving the urethra who was treated with carbon dioxide laser vaporization. RESULTS: Treatment with carbon dioxide laser vaporization resulted in an excellent cosmetic and functional status outcome for the glans penis and urethral lesions. CONCLUSION: Carbon dioxide laser vaporization is probably the initial elective treatment for erythroplasia of Queyrat with urethral involvement in young immunocompetent patients. A follow-up is necessary, and new sessions of treatment should be quickly performed if recurrence occurs.

Intraoral grafting of an ex vivo produced oral mucosa equivalent: a preliminary report.

The objective of this study was to assess the efficacy of the use of an ex vivo produced oral mucosa equivalent (EVPOME) for intraoral grafting procedures. Autogenous keratinocytes were harvested from a punch biopsy 4 weeks prior to surgery, placed in a serum-free culture system and seeded onto a human cadaveric dermal equivalent, AlloDerm. Thirty patients with either a premalignant or cancerous lesion were triaged into two groups, depending on the stage of disease: Group 1: EVPOME or Group 2: AlloDerm, control without an epithelial layer. Clinically, EVPOME grafts were easy to handle and showed excellent compliance on grafting. Both, EVPOME and AlloDerm grafts, showed a 100% take rate. At 6 days post-grafting, the EVPOME clinically showed changes indicating vascular ingrowth and had cytologic evidence of the persistence of grafted cultured keratinocytes on the surface. The EVPOME grafts had enhanced maturation of the underlying submucosal layer associated with rapid epithelial coverage when compared to the AlloDerm grafts at biopsies taken at 28 days post-grafting. In summary, EVPOME appears to be an acceptable oral mucosal substitute for human intraoral grafting procedures and results in a more favorable wound healing response than AlloDerm alone.