Women with diabetes need support and reassurance about their ability to control blood glucose and have a successful pregnancy while coping with the multiple challenges inherent in diabetes management and pregnancy. To increase uptake of pre-pregnancy care, a norm needs to be established that situates pre-pregnancy care as something every woman with diabetes will do, whether or not she is actively contemplating becoming a mother at the time. Active use of social media and facilitating peer support should be encouraged in pre-pregnancy services to facilitate attendance. The time has come to incorporate the skills of a clinical psychologist in the delivery of a pre-pregnancy service.
Oral cancer develops in precursor lesions referred to as the group of premalignant disorders (PMDs) by the World Health Organization (WHO). Some lesions are relatively common affecting between 1 and 5% of the population (leukoplakia) and may resemble benign and prevalent mucosal disease. These lesions pose a risk for malignancy that is independent of tobacco or alcohol, with a wide range of transformation rates between 13 and 70%. The commonest types are white patches (leukoplakia), red patches (erythroplakia) and submucous fibrosis. Knowledge of the patterns of clinical presentation of PMDs is important in order to screen patients effectively, identifying those who benefit from a close observation, those who require from targeted biopsy and those who may be safely followed up in primary care. We describe clinical features of the most well-documented premalignant disorders discussing lesion-specific risk predictors and treatment options. We also present a brief outline of the less prevalent group or premalignant systemic conditions including those that predispose to the development of mucosal squamous carcinoma and those that associate with the development of cutaneous squamous carcinoma. Genetic pathways involved in the development and progression of PMDs are outlined, and finally, we describe best practices for carrying out a diagnostic tissue biopsy.
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