Oral Dysplasia: Biomarkers, Treatment, and Follow-up

Abstract

Dysplasia affecting the oral mucosa has a malignant potential. The options for treatment of oral dysplasia are limited. Surgery remains the mainstay of management, with no strong evidence for medical treatments currently available. Histological grading alone does not accurately predict which dysplastic lesions will progress to cancer, which poses the clinician with difficult decisions regarding the most appropriate treatment and may lead to some patients being overtreated, with potentially unnecessary morbidity. The use of biomarkers may help to improve prediction of which cases are likely to transform. The efficacy of individual markers for prediction will be discussed in this paper. There is also a lack of consensus on the optimal frequency and duration of follow-up for patients with oral dysplasia.

The Evaluation of Ghrelin Expression In Oral Leukoplakia And Oral Squamous Cell Carcinoma: An Immunohistochemical Study

“…DISCUSSION Biomarkers are proteins or genes that are differentially expressed in normal tissue, premalignant lesions, and cancer, and this difference may help to predict the clinical outcome. 23 OSCC carcinogenesis is a multistep process involving biomolecular changes, premalignant lesions, and invasive cancer. 7,24 When the biomolecular changes begin in tissue, it is possible that the earliest mutations cause only increased keratin formation without visible dysplasia.…”

“…Numerous studies have compared the biological properties of premalignant lesions with their malignant potential; to this end, the expression of some biomarkers in oral precancerous and cancerous lesions have been compared. 6,23,[25][26][27][28] The molecular events that cause a premalignant lesion to turn into a carcinoma are still unknown, and it is still impossible to predict which premalignant lesion will progress to carcinoma. 29 …”

“…CONCLUSION Some biomarkers have been shown to have statistically significant ability to predict malignant transformation in oral dysplasia. 23 The role of ghrelin in oral carcinogenesis is not fully understood, but the ghrelin expression changes in oral carcinogenesis may be a biomarker that can improve the identification of increased malignant potential. Further studies using larger sample sizes will determine the value of ghrelin as a potential biomarker for oral carcinogenesis.…”

Loss of DLC1 is an independent prognostic factor in patients with oral squamous cell carcinoma

“…However, screening for head and neck cancer in premalignant stages and identifying oral premalignant lesions (dysplasia) at high risk of transformation is currently unpredictable. [5][6][7][8]41,42 Furthermore, the histological diagnosis of dysplasia can be subjective and is thus prone to considerable variations in interpretations among pathologists. Thus, molecular biomarkers capable of identifying the subset of lesions likely to progress to cancer are required to eliminate this clinical diagnostic dilemma.…”

“…[2][3][4] Although DNA aneuploidy and grade of dysplasia have been used as predictors for progression of dysplasia to cancer, these are not accurate predictors for evaluating the risk of malignancy. [5][6][7][8] Furthermore, oral squamous cell carcinoma patients also show poor clinical outcome owing to loco-regional recurrence, metastasis, or development of second primary tumors, despite advances in combined multi-modality therapy. Such outcomes clearly reflect our lack of understanding of the molecular mechanisms underlying development and progression of oral cancer.…”