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Oral leukoplakia, oral submucous fibrosis and erythroplakia are 3 major types of oral premalignant lesions. Multiple oral premalignant lesions may possibly develop due to field cancerization, where carcinogenic exposures can cause simultaneous genetic defects to the upper aerodigestive tract epithelium, putting the epithelium at high risk for development of premalignant lesions at different stages of carcinogenesis. There have been no epidemiological studies on risk or protective factors of the disease. A case-control study was conducted with data from the baseline screening of a randomized oral cancer screening trial in Kerala, India. A total of 115 subjects with multiple oral premalignant lesions (8 -10% of oral premalignant lesions in our case series) were included: 64 subjects with oral leukoplakia and oral submucous fibrosis, 19 subjects with oral leukoplakia and erythroplakia, 22 subjects with oral submucous fibrosis and erythroplakia and 10 subjects with all 3 lesions. Individuals without oral lesions were considered controls (n‫.)377,74؍‬ The odds ratio (OR) for ever tobacco chewers was 37.8 (95% confidence interval (CI)‫-2.61؍‬ 88.1) when adjusted for age, sex, education, BMI, smoking, drinking and fruit/vegetable intake. Dose-response relationships were seen for the frequency (p<0.0001) and duration of tobacco chewing (p<0.0001) with the risk of multiple oral premalignant lesions. Whereas alcohol drinking may possibly be a risk factor for multiple oral premalignant lesions, smoking was not associated with the risk of multiple oral premalignant lesions (OR‫,9.0؍‬ 95%CI‫.)7.1-5.0؍‬ The results suggest that tobacco chewing was the most important risk factor for multiple oral premalignant lesions and may be a major source of field cancerization on the oral epithelium in the Indian population.

The results of this study suggest a regulatory role for NF-kappaB on activation of gelatinases during malignant transformation in the oral mucosa.

Recent studies have suggested role of diabetes mellitus in the development of periodontal diseases, oral inflammatory and neoplastic lesions. We analysed data from randomised oral cancer screening trial in Kerala, India, to study the association between chronic diseases in general, diabetes mellitus in particular, and pre-malignant oral lesions and conditions. A total of 927 subjects with oral leukoplakia, 170 with oral submucous fibrosis, 100 with erythroplakia lesions and 47,773 apparently healthy subjects constituted the cases and controls respectively for our present study. The odds ratio (OR) for oral leukoplakia among women with a history of diabetes mellitus was found to be 2.0 (95% confidence interval (CI) 5 1.4-2.9) whereas that for erythroplakia was 3.2 (95% CI 5 1.3-7.9), after adjusting for potential confounders. No statistically significant association between diabetes mellitus and oral submucous fibrosis and pre-cancerous lesions/conditions in men was found. An association between diabetes mellitus and premalignant oral lesions among women has been observed in our study, although the underlying mechanisms are not clear. This needs to be further evaluated in other settings. ' 2005 Wiley-Liss, Inc.Key words: pre-malignant oral conditions; diabetes mellitus; chronic diseases Betel quid chewing with or without tobacco, smoking and alcohol drinking are well-established risk factors for pre-malignant oral diseases.1 Recently attempts have also been made to investigate an association between clinical variables and risk of premalignant oral diseases. Past history of diabetes has been linked with development of pre-malignant oral diseases in a few studies.2,3 An association between diabetes mellitus and periodontal and oral diseases, and various inflammatory lesions in oral cavity has also been demonstrated. 4 An association between diabetes mellitus and cancers of the colon, 5 endometrium, 6 kidney, 7 pancreas 8 and stomach 9 has been reported in recent literature. Our study addresses the association between chronic diseases, including diabetes mellitus and oral leukoplakia, erythroplakia and submucous fibrosis.Our present study is based on the data collected from the first round of intervention from a randomised oral cancer screening trial in Kerala, India. 10 We have reported previously the role of chewing betel quid with and without tobacco, alcohol, body mass index (BMI) and socio-economic status in development of premalignant oral lesions using the same data set. [11][12][13][14][15] We considered a total of 927 leukoplakia, 100 erythroplakia and 170 submucous fibrosis cases and 47,773 controls to assess the role of various chronic diseases, diabetes mellitus in particular, in the development of pre-malignant oral lesions. To our knowledge, this is the first large study on this topic. Material and methodsA cluster randomised, controlled oral cancer screening trial was conducted in the Trivandrum district, India, to evaluate the efficacy of screening in reducing oral cancer mortality. Details of study...

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A case of delayed pulmonary metastases from an ameloblastoma of the mandible, which occurred 20 years after surgical resection of the primary tumor but with no recurrence at the primary site, is reported. Combination chemotherapy using cisplatin, adriamycin, and cyclophosphamide has produced a very good clinical and radiologically documented response in this case.