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The recent development of novel biologic immunomodulators effective in the treatment of immune-mediated inflammatory conditions has led to their widespread use in rheumatology and dermatology. These include the tumour necrosis factor-alpha antagonists, infliximab, etanercept and adalimumab and the T-cell modulator modifiers efalizumab and alefacept. In dermatology, although these agents are licensed only for psoriasis, increasingly off-label use has extended to a number of conditions in which oral mucosal disease is a significant component. These include Behçet's disease, recurrent apthous stomatitis, benign mucous membrane pemphigoid and lichen planus. This article provides a review of the current literature on such off-label use in oral mucosal disease.

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Warthin's tumour is considered heterogeneous as to its pathogenesis with some data supporting a polyclonal origin for the epithelium, implying a non-neoplastic nature. After inconsistent reports, current information from molecular studies suggests that a recurrent t(11;19) and associated CRTC1-MAML2 fusion oncogene characterizes a subset of Warthin's tumours and supports a clonal origin in such cases. CRTC1-MAML2 is also a frequent feature of mucoepidermoid carcinoma. These findings, and the recent reports of Warthin's tumour and co-existent mucoepidermoid carcinoma with common CRTC1-MAML2 expression, provide a morphological and molecular framework for future studies as a basis for a fresh appraisal of the pathogenesis of Warthin's tumour. The underlying molecular basis and the pivotal studies defining such events are discussed.

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