Oral Potentially Malignant Disorders: Clinical Manifestations and Malignant Transformation

Oral potentially malignant disorders (OPMDs)” are diseases or conditions that carry risks of oral cancer consisting of leukoplakia, erythroplakia, palatal lesions in reverse smoker, oral submucous fibrosis, lichen planus, discoid lupus erythematosus, actinic cheilitis and inherited cancer syndromes. Each of these OPMDs has different prevalence, clinical manifestations and malignant potential. However, the clinical presentations of some OPMDs may resemble those soft tissue lesions which do not carry risk of oral cancer. Therefore, they become challenges for dentists to make appropriate diagnosis.

This literature review will mainly focus on the clinical manifestations and malignant transformation of OPMDs including leukoplakia, erythroplakia, palatal lesions in reverse smoker, oral submucous fibrosis, lichen planus, discoid lupus erythematosus and actinic cheilitis.

Mello FW, Miguel AFP, Dutra KL, et al. Prevalence of oral potentially malignant disorders: A systematic review and meta-analysis. J Oral Pathol Med 2018; 47(7): 633-640.

Manthapuri S, Sanjeevareddygari S. Prevalence of potentially malignant disorders: An institutional study. Int J App Dent Sci 2018; 4(4): 101-103

Zaw K-K, Ohnmar M, Hlaing M-M, et al. Betel Quid and Oral Potentially Malignant Disorders in a Periurban Township in Myanmar. PLoS One 2016; 11(9): e0162081.

Regezi JA, Scuibba JJ, Jordan RCK. Oral Pathology : Clinical Pathologic Correlations. 7th ed. St. Louis: Elsevier; 2016

Felix DH, Luker J, Scully C. Oral medicine: 1. ulcers: aphthous and other common ulcers. Dent Update 2012; 39(7): 513-519.

Scully C, Felix DH. Oral Medicine — update for the dental practitioner: oral white patches. Br Dent J 2005; 199(9): 565–572.

Scully C, Felix DH. Oral Medicine — update for the dental practitioner: red and pigmented lesions. Br Dent J 2005; 199(10): 639–645.

Warnakulasuriya S, Johnson NW, van der Waal I. Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med 2007; 36(10): 575-580.

George A SB, Sunil S, Varghese SS, Thomas J, Gopakumar D, Mani V. Potentially malignant disorders of oral cavity. J Oral Maxillofac Pathol 2011; 2(1): 95-100.

Goodson ML, Sloan P, Robinson CM, Cocks K, Thomson PJ. Oral precursor lesions and malignant transformation--who, where, what, and when? Br J Oral Maxillofac Surg 2015; 53(9): 831-835.

Petti S. Pooled estimate of world leukoplakia prevalence: a systematic review. Oral Oncol 2003; 39: 770-780.

Holmstrup P, Vedtofte P, Reibel J, Stoltze K. Long-term treatment outcome of oral premalignant lesions. Oral Oncol 2006; 42(5): 461-474.

Warnakulasuriya S, Ariyawardana A. Malignant transformation of oral leukoplakia: a systematic review of observational studies. J Oral Pathol Med 2016; 45(3): 155-166.

Warnakulasuriya S. Clinical features and presentation of oral potentially malignant disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2018; 125(6): 582-590.

Agha-Hosseini F SN, SadrZadeh-Afshar MS. Evaluation of potential risk factors that contribute to malignant transformation of oral lichen planus: a literature review. J Contemp Dent Prac 2016; 17: 692-701.

Szarka K TI, Fehe´r E, Ga´ll T, et al. Progressive increase of human papillomavirus carriage rates in potentially malignant and malignant oral disorders with increasing malignant potential. Oral Microbiol Immunol 2009; 24: 314–318.

Mccormick NJ, Peter JT, Carrozzo M. The clinical presentation of oral potentially malignant disorders. Prim Dent J 2016; 5: 52-57.

Kramer IRH, Lucas RB, Pindborg JJ, Sobin LH, . Definition of leukoplakia and related lesions: An aid to studies on oral precancer. Oral Surg 1978; 46(6): 518-539.

van der Waal I. Potentially malignant disorders of the oral and oropharyngeal mucosa; terminology, classification and present concepts of management. Oral Oncol 2009; 45(4-5): 317-323.

Cerero-Lapiedra R, Balade-Martinez D, Moreno-Lopez LA, Esparza-Gomez G, Bagan JV. Proliferative verrucous leukoplakia: A proposal for diagnostic criteria. Med Oral Patol Oral Cir Bucal 2010; 15(6): e839-e845.

Narayan TV, Shilpashree S. Meta-analysis on clinicopathologic risk factors of leukoplakias undergoing malignant transformation. J Oral Maxillofac Pathol 2016; 20(3): 354-361.

Holmstrup P. Oral erythroplakia-What is it? Oral Dis 2018; 24(1-2): 138-143.

Yang SW, Lee YS, Chang LC, Hsieh TY, Chen TA. Outcome of excision of oral erythroplakia. Br J Oral Maxillofac Surg 2015; 53(2): 142-147.

Bouquot JE, Ephros H. Erythroplakia: the dangerous red mucosa. Pract Periodontics Aesthet Dent 1995; 7(6): 59-68.

Reichart PA, Philipsen HP. Oral erythroplakia--a review. Oral Oncol 2005; 41(6): 551-561.

Bharath TS, Kumar NG, Nagaraja A, Saraswathi TR, Babu GS, Raju PR. Palatal changes of reverse smokers in a rural coastal Andhra population with review of literature. J Oral Maxillofac Pathol 2015; 19(2): 182-187.

Ramesh T, Sudhakara Reddy R, Sai Kiran CH, Lavanya R, Naveen KB. Palatal changes in reverse and conventional smokers – A clinical comparative study in South India. Indian Journal of Dentistry 2014; 5: 34-38.

Reddy CR. Carcinoma of hard palate in India in relation to reverse smoking of chuttas. J Natl Cancer Inst 1974; 53(3): 615-619.

Wollina U, Verma SB, Ali FM, Patil K. Oral submucous fibrosis: an update. Clin Cosmet Investig Dermatol 2015; 8: 193-204.

Yang PY, Chen YT, Wang YH, Su NY, Yu HC, Chang YC. Malignant transformation of oral submucous fibrosis in Taiwan: a nationwide population-based retrospective cohort study. J Oral Pathol Med 2017; 46(10): 1040-1045.

Awadallah M, Idle M, Patel K, Kademani D. Management update of potentially premalignant oral epithelial lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2018; 125(6): 628-636.

Neville BW, Damm DD, Allen CM, Chi AC. Oral and Maxillofacial Pathology. 4th Edition. St. Louis: Elsevier; 2016

Hazarey VK ED, Mundhe KA, Ughade SN. Oral submucous fibrosis: study of 1000 cases from central India. J Oral Pathol Med 2007; 36: 12-17.

Wang YY, Tail YH, Wang WC, et al. Malignant transformation in 5071 southern Taiwanese patients with potentially malignant oral mucosal disorders. BMC Oral Health 2014; 14(99).

Bombeccari GP, Guzzi G, Tettamanti M, et al. Oral lichen planus and malignant transformation: a longitudinal cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112(3): 328-334.

Cheng YS, Gould A, Kurago Z, Fantasia J, Muller S. Diagnosis of oral lichen planus: a position paper of the American Academy of Oral and Maxillofacial Pathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2016; 122(3): 332-354.

Lodi G, Scully C, Carrozzo M, Griffiths M, Sugerman PB, Thongprasom K. Current controversies in oral lichen planus: report of an international consensus meeting. Part 1. Viral infections and etiopathogenesis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100(1): 40-51.

Thongprasom K, Luangjarmekorn L, Sererat T, Taweesap W. Relative efficacy of fiuocinolone acetonide compared with triamcinolone acetonide in treatment of oral lichen planus. J Oral Pathol Med 1992; 21: 456-458.

van de Meij, van de Waal. Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications. J Oral Pathol Med 2003; 32: 507-512.

Holmstrup JT, Rindum J, Pindborg JJ. Malignant development of lichen planus-affected oral mucosa. J Oral Pathol Med 1988; 17: 219-225.

Silverman S GM, Lozada-Nur F, Giannotti K. A prospective study of findings and management in 214 patients with oral lichen planus. Oral Surg Oral Med Oral Pathol 1991; 72: 665-670.

Manomaivat T, Pongsiriwet S, Kuansuwan C, Thosaporn W, Tachasuttirut K, Iamaroon A. Association between hepatitis C infection in Thai patients with oral lichen planus: A case-control study. J Investig Clin Dent 2018; 9(2): e12316.

Gorsky M, Epstein JB. Oral lichen planus: malignant transformation and human papilloma virus: a review of potential clinical implications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 111(4): 461-464.

Ostwald C, Rutsatz K, Schweder J, Schmidt W, Gundlach K, Barten M. Human papillomavirus 6/11, 16 and 18 in oral carcinomas and benign oral lesions. Med Microbiol Immunol 2003; 192(3): 145-148.

Furrer VE, Benitez MB, Furnes M, Lanfranchi HE, Modesti NM. Biopsy vs. superficial scraping: detection of human papillomavirus 6, 11, 16, and 18 in potentially malignant and malignant oral lesions. J Oral Pathol Med 2006; 35: 338-344.

Aghbari SMH, Abushouk AI, Attia A, et al. Malignant transformation of oral lichen planus and oral lichenoid lesions: A meta-analysis of 20095 patient data. Oral Oncol 2017; 68: 92-102.

Giuliani M, Troiano G, Cordaro M, et al. Rate of malignant transformation of oral lichen planus: A systematic review. Oral Dis 2019; 25(3): 693-709.

Imanguli MM, Alevizos I, Brown R, Pavletic SZ, Atkinson JC. Oral graft-versus-host disease. Oral Dis 2008; 14(5): 396-412.

Curtis RE, Metayer C, Rizzo JD, et al. Impact of chronic GVHD therapy on the development of squamous-cell cancers after hematopoietic stem-cell transplantation: an international case-control study. Blood 2005; 105(10): 3802-3811.

Shimada K, Yokozawa T, Atsuta Y, et al. Solid tumors after hematopoietic stem cell transplantation in Japan: incidence, risk factors and prognosis. Bone Marrow Transplant 2005; 36(2): 115-121.

Liu W, Shen ZY, Wang LJ, et al. Malignant potential of oral and labial chronic discoid lupus erythematosus: a clinicopathological study of 87 cases. Histopathology 2011; 59(2): 292-298.

Jemec GB, Ullman S, Goodfield M, et al. A randomized controlled trial of R-salbutamol for topical treatment of discoid lupus erythematosus. Br J Dermatol 2009; 161(6): 1365-1370.

Dieng MT, Ndiaye B. Squamous cell carcinoma arising on cutaneous discoid lupus erythematosus. Report of 3 cases. Dakar Medical 2001; 46(1): 73-75

Ee HL, Ng PPL, Tan SH, Goh CL. Squamous cell carcinoma developing in two Chinese patients with chronic discoid lupus erythematosus: the need for continued surveillance. Clin Exp Dermatol 2006; 31(4): 542-544.

Wood NH, Khammissa R, Meyerov R, Lemmer J, Feller L. Actinic cheilitis: a case report and a review of the literature. Eur J Dent 2011; 5: 101-106.

Dancyger A, Heard V, Huang B, Suley C, Tang D, Ariyawardana A. Malignant transformation of actinic cheilitis: A systematic review of observational studies. J Investig Clin Dent 2018; 9(4): e12343.

Markopoulos A, Albanidou-Farmaki E, Kayavis I. Actinic cheilitis: clinical and pathologic characteristics in 65 cases. Oral Dis 2004; 10: 212–216.

Sangkaew P, Itthichaicharoen J, Iamaroon A, Prapayasatok S, Pongsiriwet S. Oral Potentially Malignant Disorders: Clinical Manifestations and Malignant Transformation: Review articles. CM Dent J [Internet]. 2019 Sep 09 [cited 2024 Nov 18];40(3):23-42. Available from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=96

Sangkaew, P., Itthichaicharoen, J., Iamaroon, A., Prapayasatok, S. & Pongsiriwet, S. (2019). Oral Potentially Malignant Disorders: Clinical Manifestations and Malignant Transformation. CM Dent J, 40(3), 23-42. Retrieved from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=96

Sangkaew, P., Itthichaicharoen Jitjiroj,Iamaroon Anak,Prapayasatok Sangsom and Pongsiriwet Surawut. 2019. "Oral Potentially Malignant Disorders: Clinical Manifestations and Malignant Transformation." CM Dent J, 40(3), 23-42. https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=96

Sangkaew, P. et al. 2019. 'Oral Potentially Malignant Disorders: Clinical Manifestations and Malignant Transformation', CM Dent J, 40(3), 23-42. Retrieved from https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=96

Sangkaew, P., Itthichaicharoen, J., Iamaroon, A., Prapayasatok, S. and Pongsiriwet, S. "Oral Potentially Malignant Disorders: Clinical Manifestations and Malignant Transformation", CM Dent J, vol.40, no. 3, pp. 23-42, Sep. 2019.

Sangkaew, P., Itthichaicharoen, J., Iamaroon, A., et al. "Oral Potentially Malignant Disorders: Clinical Manifestations and Malignant Transformation." CM Dent J, vol.40, no. 3, Sep. 2019, pp. 23-42, https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=96