The aim of our study was to analyze the alterations of some candidate tumor suppressor genes (TSGs) viz. LIMD1, LTF, CDC25A, SCOTIN, RASSF1A and CACNA2D2 located in the chromosomal region 3p21.31 associated with the development of early dysplastic lesions of head and neck. In analysis of 72 dysplastic lesions and 116 squamous cell carcinoma of head and neck, both deletion and promoter methylation have been seen in these genes except for CDC25A and SCOTIN where no methylation has been detected. The alteration of LIMD1 was highest (50%) in the mild dysplastic lesions and did not change significantly during progression of tumor indicating its association with this stage of the disease. It was evident that alterations of LTF, CDC25A and CACNA2D2 were associated with development of moderate dysplastic lesions, while alterations in RASSF1A and CACNA2D2 were needed for progression. Novel somatic mutations were seen in exon 1 of LIMD1 (7%), intron 3/exon4 splice junction of LTF (2%) and exon 7 of cdc25A (10%). Quantitative RT-PCR analysis revealed mean reduced expression of the genes in the following order: LTF (67.6 6 16.8) > LIMD1 (53.2 6 20.1) > CACNA2D2 (23.7 6 7.1) > RASSF1A (15.1 6 5.6) > CDC25A (5.3 6 2.3) > SCOTIN (0.58 6 0.54). Immunohistochemical analysis of CDC25A showed its localization both in cytoplasm and nucleus in primary lesions and oral cancer cell lines. In absence of HPV infection, LTF and RASSF1A alterations jointly have adverse impact on survival of tobacco addicted patients. Thus, our data suggested that multiple candidate TSGs in the chromosomal 3p21.31 region were differentially associated with the early dysplastic lesions of head and neck. ' 2008 Wiley-Liss, Inc.Key words: dysplastic lesions; expression; head and neck squamous cell carcinoma; mutation; 3p21.31; survival study; tumor suppressor genes; methylation Head and neck squamous cell carcinoma of (HNSCC) is the sixth most common cancer worldwide and it accounts for 30-40% of all cancer types in Indian subcontinent.1 HNSCC is a heterogeneous epithelial malignant disease arising from mucosa of the upper aerodigestive tract (oral cavity, larynx, oropharynx and hypopharynx) with complex molecular abnormalities. Although the major and common environmental carcinogenic risk factors of tobacco, alcohol, betel quid and HPV infection have long been recognized, details of the genetic and epigenetic events leading to the development and spread of HNSCC remain largely unknown. Array-based gene expression profiling focused the transition of normal mucosa to premalignant lesion as the most important event with majority of transcriptional alterations rather than transition from premalignant lesion to invasive carcinoma during the progression of HNSCC.2 In microcell hybrid system, it has been shown that the introduction of chromosome 3 can suppress the tumorigenicity of oral cancer cell lines, suggesting the presence of at least 1 tumor suppressor gene (TSG) in this chromosome associated with the development of HNSCC.3 According to a recent tumor progr...