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Objective: To study the relationship of the expressions of p53 and mdm2 in leukoplakia cancer., Methods: RT-PCR was used to detect the mRNA of p53, mdm2 in patients with leukoplakia cancer. The frequencies of p53, mdm2 in peripheral blood were detected by flow cytometric analysis., Results: The expression of p53mRNA in normal oral mucosa, simple oral leukoplakia, no-simple oral leukoplakia and leukoplakia cancer were 7.7%, 27.3%,33.3%, 56.8%, respectively. The frequencies of p53 in normal oral mucosa, simple oral leukoplakia, no-simple oral leukoplakia and leukoplakia cancer were (0.3±0.1)%, (1.6±0.9)%, (1.9±1.1)%, (3.4±1.8)%. The expression of mdm2 mRNA in normal oral mucosa, simple oral leukoplakia, no-simple oral leukoplakia and leukoplakia cancer were 0.0%, 6.8%, 11.1%, 37.8%, respectively. The frequencies of mdm2 in normal oral mucosa, simple oral leukoplakia, no-simple oral leukoplakia and leukoplakia cancer were (0.1±0.1)%, (0.8±0.6)%, (1.2±0.8)%, (1.2±0.8)%. There was a positively correlation between p53 mRNA and mdm2 mRNA., Conclusions: The positive rate of p53 and mdm2 cells in the peripheral blood increases in patients with leukoplakia cancer tissue and has positive correlation with the severity of leukoplakia cancer., (Copyright © 2013 Hainan Medical College. Published by Elsevier B.V. All rights reserved.)

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Objectives Materials and Methods Results Conclusions To update the current evidence on the malignant transformation of oral leukoplakia (OL), including all studies published worldwide on the subject, selected with the maximum rigor regarding eligibility.MEDLINE, Embase, Web of Science and Scopus were searched for studies published before June‐2024, with no lower date limit. The risk of bias was analyzed using the Joanna Briggs Institute tool for meta‐analyses of proportions. We carried out meta‐analyses, explored heterogeneity across subgroups and identified risk factors with potential prognostic value.Fifty‐five studies (41,231 with OL) were included. The pooled malignant transformation proportion for OL was 6.64% (95% CI = 5.21–8.21). The malignant transformation did not significantly vary by time periods (p = 0.75), 5.35% prior to 1978, 7.06% from 1979 to 2007 and 6.97% during more recent times. The risk factors that significantly had a higher impact on malignant transformation were the non‐homogeneous leukoplakias (RR = 4.23, 95% CI = 3.31–5.39, p < 0.001), the larger size (RR = 2.08, 1.45–2.96, p < 0.001), leukoplakia located on the lateral border of tongue (malignant transformation = 12.71%; RR = 2.09, 95% CI = 1.48–2.95, p < 0.001), smoking (RR = 1.64, 95% CI = 1.25–2.15, p < 0.001), and the presence of epithelial dysplasia (RR = 2.75, 95% CI = 2.26–3.35, p < 0.001).OL presents a considerable malignant transformation probability that is especially increased in large non‐homogeneous lesions in smokers, located on the lateral border of the tongue, with epithelial dysplasia. [ABSTRACT FROM AUTHOR]

Background: Several existing studies have shown a correlation between some of the blood and urine biomarkers and oral leukoplakia (OLK). However, the causality of this relationship remains uncertain. Thus, this study aimed to examine the causal association between 35 blood and urine biomarkers and OLK. Methods: Single nucleotide polymorphisms (SNPs) associated with 35 blood and urine biomarkers were selected as instrumental variables (IVs) using a twosample Mendelian randomization(MR) study to assess the causal relationship between the biomarkers and the risk of oral leukoplakia. We used the inverse variance weighted (IVW) method as the main analysis. Furthermore, several sensitivity analyses were performed to assess heterogeneity, horizontal pleiotropy, and stability. Results: Based on the selection criteria of the Inverse Variance Weighted (IVW) method, the analysis found that 5 blood and urine biomarkers were significantly associated with the development of leukoplakia, of which the results of IVW showed that abnormalities of Apolipoprotein B (Apo B), Cholesterol, Low-density Lipoprotein (LDL), Triglycerides (TG) promoted the development of oral leukoplakia, and Non Albumin Protein (NAP) had a protective effect on the development of oral leukoplakia. We then performed a Bonferroni correction for these results, and after correction Apo B was still causally associated with the development of oral leukoplakia (IVW P<0.0007), whereas the other four biomarkers could only provide some evidence of predisposition. Conclusion: Our two-sample Mendelian randomization study supports the existence of a causal relationship between these five blood and urine biomarkers and the occurrence of oral leukoplakia, and provides evidence for a number of risk and protective factors for the development of oral leukoplakia; however, the definitive mechanisms for the occurrence and development of oral leukoplakia still remain to be elucidated, and further studies on these relevant mechanisms are still needed. [ABSTRACT FROM AUTHOR]

Proliferative verrucous leukoplakia (PVL) is a non-homogenous type of oral leukoplakia, characterized by multifocal white plaques, propensity to recur after treatment, with strong tendency towards malignant transformation. Interestingly, some studies show that, at initial stages, PVL may resemble oral lichen planus (OLP), potentially leading to misdiagnosis. A 52-year-old woman, with a previous OLP diagnosis, was referred to our service for implant installation and follow-up of OLP lesions. After clinicopathological re-evaluation, a diagnosis of PVL (early stage) was made, and a maxillary full-arch implant-supported prosthesis supported by implants was installed. After 6 years of follow-up, the patient developed squamous cell carcinoma around the implants. The current case emphasizes that PVL patients with oral lesions suggesting peri-implantitis or peri-implant mucositis deserve a more meticulous investigation. [ABSTRACT FROM AUTHOR]

Aim: To estimate and compare the level of serum immunoglobulin A in patients of oral submucous fibrosis (OSMF), leukoplakia, and control group. Introduction: OSMF is a well‑recognized potentially malignant condition in the oral cavity, and a transformation rate as high as 7.6% over a period of 10 years has been reported from India. Leukoplakia has evolved as a clinico‑pathologic concept over many years, with the current clinical designation being accepted worldwide. Materials and Methods: Quantia IgA is a turbidometric immunoassay for the detection of IgA in human serum and is based on the principle of agglutination reaction. The test specimen is mixed with the activation buffer (R1) and then with antihuman IgA reagent (R2) and allowed to react. For the estimation of serum IgA, 500 μl of Quantia IgA activation buffer R1 is taken in a clean test tube. Serum sample is diluted in the ratio of 1:5 with normal saline. Ten microliters of diluted serum sample are added to R1. After incubation for 10 min, 50 μl of R2 is added, which is Quantia IgA antihuman IgA reagent to the sample, and the reading is recorded at wavelength 340 nm at 37°C. The level of IgA will be estimated by a semi‑automatic biochemical analyzer machine and then data analysis will be done. Results: The immunologic alterations observed by us in OSMF and leukoplakia are almost similar or nearer to the alterations observed in oral cancer, so it is reasonable to assume that OSMF and leukoplakia can be an intermediate stage in the transformation process of a normal cell to oral malignancy. Conclusion: Prevention and early detection is the best way to reduce the incidence and mortality of premalignant disorders and oral cancer. There are many ways and methods of early detection of premalignant disorders and oral cancer, and the immunological method is one of them. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of oral squamous cell carcinoma (OSCC) associated or not with oral potentially malignant disorders (OPMD), and the epidemiological profile and traditional risk factors in Latin America. Methods: A retrospective observational study was conducted in 17 Latin American centres. There were included cases of OSCC, analysing age, gender, OSCC and their association with previous OPMD. Clinicopathological variables were retrieved. The condition of sequential‐OSCC versus OSCC‐de novo (OSCC‐dn) was analysed concerning the aforementioned variables. Quantitative variables were analysed using Student's t‐test, and qualitative variables with chi‐square. Results: In total, 2705 OSCC were included with a mean age of 62.8 years old. 55.8% were men. 53.75% of the patients were smokers and 38% were common drinkers. The lateral tongue border was the most affected site (24.65%). There were regional variations in OPMD, being leukoplakia the most frequent. Of the overall 2705 OSCC cases, 81.4% corresponded to OSCC‐dn, while s‐OSCC were 18.6%. Regarding lip vermillion SCC, 35.7% corresponded to de novo lip SCC and 64.3% were associated with previous OPMD. Conclusions: In Latin America, OSCC‐dn seems to be more frequent with regional variations of some clinical and histopathological features. Further prospective studies are needed to analyse this phenomenon. [ABSTRACT FROM AUTHOR]

Background: This study aims to compare the efficacy between conventional exfoliative cytology (EC) and centrifuged liquid-based cytology (CLBC) in control, leukoplakia, and oral squamous cell carcinoma (OSCC) patients. Oral leukoplakia and oral cancer require an early definitive diagnosis for better prognostic outcome. Oral EC, a minimally invasive technique that involves the examination of desquamated cells from the tissue surfaces used as a method of early diagnosis. CLBC is a modified technique that is used to achieve improved quality of the cytology findings. Materials and Methods: A comparative study was done in 30 subjects, of which, 10 cases from control group, 10 oral leukoplakia, and 10 OSCC cases. These subjects were selected according to the appropriate inclusion and exclusion criteria. The cases in each group underwent conventional as well as CLBC. The comparison was carried out between these groups with respect to the cellular and background stromal factors. Appropriate qualitative evaluation of the samples was collected and statistical analysis was done using the Chi-squared test. The significance level of value was P < 0.05. Results: Significant results were obtained for certain parameters such as cellular overlap clear background, uniform distribution in control, leukoplakia, and OSCC with a P = 0.004**, P = 0.001**, P = 0.006** using CLBC. Conclusion: CLBC is better and give clearer vision as compared to conventional cytology and can be used in the early diagnosis. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to compare the reproducibility and consistency of the World Health Organization (WHO) and Binary oral epithelial dysplasia grading systems when applied to leukoplakic lesions, the most common oral potentially malignant disorders (OPMDs). Methods In this retrospective, cross-sectional study, clinical data and microscopic slides of 89 leukoplakia cases were reviewed. Two pathologists independently graded each sample using both WHO and Binary systems. Inter-observer agreement was evaluated using kappa statistics. The relationship between variables and the grade of dysplasia was analyzed using T-test and Chisquare test at p<0.05. Results The mean age of cases was 53.93 ± 13.84 years, with a slight female predominance. The lesions were most commonly located on the tongue (38.2%) and buccal mucosa (37.08%). The inter-observer agreement was higher for the Binary system (kappa index= 0.62) compared to the WHO system (kappa index= 0.46). The highest agreement was observed for cellular features such as the increased number of cell nucleoli (0.74) and cell pleomorphism (0.73), while keratin pearls showed the lowest agreement (0.21). Conclusion The Binary classification system demonstrated superior consistency and reproducibility compared to the WHO system due to fewer grading categories. However, its detailed numerical requirements and time-consuming nature may limit its widespread adoption, which is why the WHO system is more commonly used. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions Oral leukoplakia (OL) is one of the most common and investigated oral potentially malignant disorders (OPMD). Preventing OSCC occurrence should be the primary outcome in the clinical management of OL. Surgical removal of OL is performed by most clinicians, although its effectiveness in reducing OSCC onset has still not been established by randomized controlled trials (RCT). Wait and see approach is characterized by frequent clinical examinations and periodical biopsies of OL, avoiding unnecessary surgical procedures.This is the first multicenter RCT in literature aiming at comparing the effectiveness of surgical removal and the “wait and see” approach in preventing OSCC onset in patients affected by dysplastic and non‐dysplastic OL.Two Italian referral care centres for oral diseases were involved in this multicenter two‐arm RCT comparing the surgical removal of OL (group A) and the “wait and see” approach (group B), with the aim of reducing oral cancer onset.This report shows preliminary data on the first 161 patients, with a mean follow‐up of 19.14 ± 11.25 months. Eight cases of OSCC occurred (6 out 8 involving the tongue): one case in group A and seven cases in group B. Moreover, OL recurred in 13 (20%) cases after surgical excision.Within the limitations of this preliminary report, these initial data underline the increased risk of OSCC onset in the case of OL of the tongue in the presence of epithelial dysplasia in group B (“wait and see”) compared to group A (surgery). This RCT is currently ongoing at the same clinical departments, with the aim of enrolling 310 patients and collecting data at 5‐year follow‐up, in order to achieve conclusive results, in an evidence‐based medicine approach. [ABSTRACT FROM AUTHOR]

Intermediate filaments are one of three polymeric structures that form the cytoskeleton of epithelial cells. In the epithelium, these filaments are made up of a variety of keratin proteins. Intermediate filaments complete a wide range of functions in keratinocytes, including maintaining cell structure, cell growth, cell proliferation, cell migration, and more. Given that these functions are intimately associated with the carcinogenic process, and that hyperkeratinization is a quintessential feature of oral leukoplakias, the utility of keratins in oral leukoplakia is yet to be fully explored. This scoping review aims to outline the current knowledge founded on original studies on human tissues regarding the expression and utility of keratins as diagnostic, prognostic, and predictive biomarkers in oral leukoplakias. After using a search strategy developed for several scientific databases, namely, PubMed, Scopus, Web of Science, and OVID, 42 papers met the inclusion and exclusion criteria. One more article was added when it was identified through manually searching the list of references. The included papers were published between 1989 and 2024. Keratins 1–20 were investigated in the 43 included studies, and their expression was assessed in oral leukoplakia and dysplasia cases. Only five studies investigated the prognostic role of keratins in relation to malignant transformation. No studies evaluated keratins as a diagnostic adjunct or predictive tool. Evidence supports the idea that dysplasia disrupts the terminal differentiation pathway of primary keratins. Gain of keratin 17 expression and loss of keratin 13 were significantly observed in differentiated epithelial dysplasia. Also, the keratin 19 extension into suprabasal cells has been associated with the evolving features of dysplasia. The loss of keratin1/keratin 10 has been significantly associated with high-grade dysplasia. The prognostic value of cytokeratins has shown conflicting results, and further studies are required to ascertain their role in predicting the malignant transformation of oral leukoplakia. [ABSTRACT FROM AUTHOR]

Dyskeratosis congenita (DKC) is a rare genetic disorder characterized by lacy reticular skin hyperpigmentation, bone marrow failure, nail dystrophy, and oral leukoplakia. To the best of our knowledge, only around 200 cases were reported in the medical literature, and in this report, we present another distinctive case from Syria. This case report describes a male patient with generalized reticular pigmentation and abnormal nails since childhood. The patient reported a history of recurrent urethral stenosis and corneal density. Dermoscopic examination revealed pigmented lines arranged in a netlike pattern. Histopathological findings were nonspecific. Hematological values were unremarkable. A contrast CT scan revealed changes in the bladder wall. The final diagnosis of Dyskeratosis Congenita was made based on the clinical criteria. This disorder can present with additional cutaneous manifestations and systemic complications. Treatment are generally prescribed to maintain bone marrow function, based on the fact that it is the major cause of death. Regular monitoring and screening for associated conditions are recommended. [ABSTRACT FROM AUTHOR]

We have observed a distinct phenomenon of transient oral lingual leukoplakia in infancy and report 22 healthy infants with gray–white plaques on the dorsal tongue with sparing of the tip from four medical centers in three countries. The onset of the eruption ranged from 1 week to 7 months of life and resolved in 19 patients (86%, with 3 patients lost to follow‐up). None of the eight patients examined at 1 year of age had residual findings. We believe this is a common entity that can be distinguished from oral candidiasis on clinical and/or laboratory examination and name this entity "transient infantile lingual leukoplakia." [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to identify and analyze the existing literature on the utility of podoplanin to predict the risk of malignancy development (MD) in patients previously diagnosed with oral leukoplakia (OL). Methods: A systematic review and meta‐analysis (SRMA) was performed though a search strategy using several electronic databases and a combination of keywords related to podoplanin and MD of OL, until 15 May, 2022 (PROSPERO CRD42022329326). Evaluation of the risk of bias (ROB) was performed using the Quality in Prognosis Studies Tool. The meta‐analyses were estimated using fixed‐effect models. Results: From 421 articles, 6 studies were finally included, that enrolled 546 patients with OL, of whom 125 presented with an oral cancer during follow‐up (32 to 90 months). Some limitations regarding the ROB were identified mostly related to small sample sizes, short follow‐up times, lack of information on covariables in the included studies and lack of accuracy (including sensitivity and specificity). Meta‐analysis of 6 studies reveal that high expression of podoplanin carries a pooled hazard ratio (HR) of 3.72 (95% CI, 2.40–5.76; p < 0.00001) for MD without statistical heterogeneity (I2 = 0%, p = 0.53). Conclusion: The results of this SRMA support the role of podoplanin immunohistochemical expression as a potential predictive biomarker to assess the risk of malignancy development in oral leukoplakia. [ABSTRACT FROM AUTHOR]

The term dermatoglyphics was first used in 1926 by anatomist Cummins. Dermatoglyphic is a term that refers to “a skin carving.” The unique carve present on the skin surface of humans and other living beings is referred to as dermatoglyphics. This research was conducted to understand the variations in patterns and assess the usefulness of dermatoglyphics among individuals diagnosed with potentially malignant diseases and mouth cancer. Three hundred subjects were selected. The study consisted of three groups. Patients were divided into the following groups: Group I: oral submucous fibrosis (OSMF) (100), Group II: ORAL LEUKOPLAKIA (100), and Group III: Healthy Individuals (100). Our research study indicates a difference in dermatoglyphic patterns between patients and healthy individuals. Specifically, there is a lower percentage of loop patterns and an increase in arch patterns in OSMF and leukoplakia patients. These findings suggest that dermatoglyphics may have relevance in understanding or identifying certain health conditions. [ABSTRACT FROM AUTHOR]

CD44 and SALL4 are markers of stemness and expressed in cancer stem cells (CSCs). Their deregulated expression was seen in various tumors and has been correlated with clinical severity. We evaluated immunohistochemical expression of CD44 and SALL4 in leukoplakia and oral squamous cell carcinoma (OSCC). CD44 was expressed in all the cases of leukoplakia and Its expression correlated with severity of the dysplasia in leukoplakia but varied with differentiation in OSCC. SALL4 did not express in leukoplakia. Its expression was varied in OSCC cases. We opine that CD44 expression is consistent with the progression of dysplasia in leukoplakia and differentiation in OSCC. [ABSTRACT FROM AUTHOR]

Simple Summary: Early diagnosis of potentially malignant oral disorders (OPMD) is crucial in reducing oral cancer mortality. It is necessary to investigate and identify predictive biomarkers capable of estimating the risk of malignant transformation in potentially malignant oral lesions. In this study, we analyzed a panel of salivary markers, including adenosine deaminase (ADA), ferritin (FRR) and total protein (TP). We found no significant differences in salivary ADA between the OPMD group and controls. However, we did observe statistically significant differences in ferritin and total proteins when compared to the control group. Therefore, ferritin and total proteins may serve as potential salivary biomarkers for diagnosis. Furthermore, saliva tests are a reliable and non-invasive diagnostic tool, offering an intriguing alternative for screening large populations. Nevertheless, validation through extensive clinical studies is required. Introduction: Oral potentially malignant disorders (OPMD) are lesions associated with an increased risk of transformation (MT) into cancer. Objective: A study was made of the salivary levels of adenosine deaminase (ADA), ferritin (FRR) and total proteins (TP) in healthy individuals and in patients with oral potentially malignant disorders (OPMD), assessing the potential role of saliva as a diagnostic tool. Methods: A total of 91 subjects participated in the study, divided into two groups—59 patients with OPMD (oral leukoplakia or oral lichen planus) and 32 healthy controls—with measurements being made of salivary ADA, ferritin (FRR) and total proteins (TP). Results: There were no significant differences in salivary mean ADA between the OPMD group 0.85 ± 2.18 UI/I and the controls 0.71 ± 1.72 UI/I (p = 0.934), though the levels of both FRR mean OPMD, 12.66 ± 10.50 (µg/L), versus control, 7.19 ± 4.44 (p = 0.001), and TP, 23.41 ± 17, versus control, 14.15 ± 15.19, were significantly higher in the OPMD group (p = 0.001). Patients with oral lichen planus showed significant differences in terms of FRR (p = 0.009) and TP (p = 0.003). The ferritin in LPO with a cut-off point of 8.5C showed a sensitivity and specificity of 54.3% and 82.3, respectively. The area under the curve (AUC) was 0.69 (95% confidence interval (95% CI): 0.58–0.82; p = 0.003). Conclusions: Ferritin and total proteins may constitute potential salivary biomarkers for oral lichen planus, though further studies are still needed in this field. In addition, saliva testing is a reliable and noninvasive diagnostic tool and appears to be a reliable strategy offering an interesting alternative for the screening of large populations. [ABSTRACT FROM AUTHOR]

Objectives: A classification and staging system for oral leukoplakia (OL) was introduced to promote uniform reporting. In this system, size and the histopathologic diagnosis are assessed and combined in a staging system. The various stages could be predictive for malignant transformation of OL. Differentiated dysplasia (DD) was recently recognized as an important architectural pattern of dysplasia and is highly associated with malignant transformation (MT) of OL. In the present study, DD was incorporated in the OL‐system. The aim of the present study was to test the adapted system on a cohort of patients with OL. Patient and methods: The group consisted of 140 patients. The size, absence or presence and degree of classic dysplasia (CD) and DD were incorporated into the OL‐system. Results: In 31/140 patients, MT occurred. Size was not statistically significant with MT (p = 0.422). The presence of dysplasia was predictive for MT (p = 0.003), whereby severe CD and DD were highly statistically significant for MT (p = 0.008). Stage IV was statistically significant for MT (p = 0.011). Conclusions: The present study emphasizes the value of the slightly modified OL‐system with incorporation of DD in uniform reporting of OL and the value in predicting MT. [ABSTRACT FROM AUTHOR]

Background: This prospective observational study investigated the determinants of malignant transformation (MT) in localized oral leukoplakia (OL) and proliferative verrucous leukoplakia (PVL). Methods: Demographic, clinical, histological, and DNA ploidy status data were collected at enrolment. Survival analysis was performed (MT being the event of interest). Results: One‐hundred and thirty‐three patients with OL and 20 patients with PVL entered the study over 6 years (mean follow‐up 7.8 years). The presence of OED, DNA ploidy, clinical presentation, and lesion site were associated with MT in patients with OL in a univariate analysis. In a multivariate model, OED was the strongest predictor of MT in patients with OL. Adding DNA ploidy increased the model's predictive power. None of the assessed predictors was associated with MT in patients with PVL. Conclusions: DNA ploidy might identify a subset OL with low risk or minimal risk of MT, but it does not seem to be a reliable predictor in patients with PVL. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of methylene blue-mediated photodynamic therapy (MB-PDT) for the treatment of oral leukoplakia (OL) and compare it to systemic Vitamin A therapy. Materials and Methods: Forty clinically and histopathologically confirmed cases of OL were included. They were divided into two groups: 20 were given systemic Vitamin A therapy and on the other group MB-PDT for 30 days. Pre- and posttreatment assessment of size of lesion and clinical appearance were done and followed up for 1 year to check for recurrence and delayed side effects. Results: The reduction in size of lesion pre- and posttreatment was statistically nonsignificant in the Vitamin A Group, but statistically highly significant in the PDT group according to unpaired t-test with no immediate or delayed side effects seen in both the groups. Conclusion: Both the treatment methods showed response in terms of reduction of size of lesion, but MB-PDT was a better treatment option for OL. Clinical Relevance: Oral cancer is often preceded by various premalignancies, OL being the most common among them. Early diagnosis and intervention will prevent malignant transformation thereby reducing the cost, side effect and mortality associated with oral cancer. Considering the prevalence, symptomless nature of OL, an effective, well-accepted mode of treatment with minimal side effects is of utmost need. [ABSTRACT FROM AUTHOR]

The definition of oral leukoplakia has not much changed during the past five decades and is still a definition by exclusion of ‘known’ lesions. Therefore, a diagnosis of leukoplakia is not always a straightforward one for the clinicians and, to some extent, also for the pathologists. The traditional clinical classification in homogeneous and nonhomogeneous leukoplakia may just be simplified into leukoplakia (thin and thick/verrucous) and erythroleukoplakia. In spite of numerous reported predictive molecular and genetic parameters of malignant transformation, the presence and grade of epithelial dysplasia as assessed by histopathological examination is still the most important one. Of the various treatment modalities, surgery and CO2 laser evaporation are still the most common ones. Treatment may delay or prevent recurrence, but does not seem to prevent malignant transformation or the occurrence of cancer development elsewhere in the mouth or the head and neck region or beyond. There is a strong need for randomized prospective studies and uniform reporting of treatment results. [ABSTRACT FROM AUTHOR]

Leukoplakia, a potentially malignant oral condition, manifests as a nonremovable white lesion that is often linked to risk factors such as smoking, alcohol, and HPV. Pegylated liposomal doxorubicin (PLD), which is used in cancer treatment, has been associated with secondary oral cancers, particularly in patients with leukoplakia. A case study revealed the development of squamous cell carcinoma (SCC) on the tongue following PLD treatment, suggesting a potential link between the drug and malignant transformation. Despite the benefits of PLD in reducing cardiac toxicity, long-term oral monitoring is essential due to the persistent risk of oral cancer posttreatment. [ABSTRACT FROM AUTHOR]

Objectives: To assess the clinicopathological characteristics of a cohort of patients with oral leukoplakia (OL) managed in a Romanian dental hospital and to evaluate the risk of malignant transformation (MT). Materials and methods: We conducted a hospital‐based retrospective study using the clinical charts of patients diagnosed with OL that had complete clinical and histopathological evaluation followed up for 1–16 years. Results: From 120 included patients, 68 (56.7%) were females, and 71 (59.2%) were current smokers. The homogeneous form was present in 60% of cases; the buccal mucosa was the most frequently involved site. MT was observed in 9 cases, which was more common in females and in those with dysplastic leukoplakia. A significant statistical association was found between MT and dysplasia grade (χ2 test: p = 0.007). MT occurred during a mean interval of time 75 months in both treated and non‐treated patients. Conclusions: In this leukoplakia cohort, most of the lesions encountered were in smokers, clinically homogeneous and 62.5% proved histologically benign. But despite the clinically benign appearance of leukoplakia, tissue diagnosis of some cases was carcinoma. The results of the current study advocate the necessity for biopsy even in apparently homogeneous, clinically benign lesions. The malignization rate was 7.5%; two‐thirds were nonhomogeneous lesions. [ABSTRACT FROM AUTHOR]

Background: Establishing the risk of malignant transformation (MT) in oral leukoplakia is usually based on grading oral epithelial dysplasia (OED) on biopsy tissue, for which two systems are proposed: a 3‐tier and a binary system. Only very few actuarial studies have tested the accuracy of such methods in predicting MT, especially for the binary system. This study aimed to assess the accuracy of the two grading systems in predicting MT in a cohort of oral leukoplakia (OL) from Brazil, with follow‐up data. Methods: The sample comprised 878 individuals diagnosed with OL from 2005 to 2018. Follow‐up data were obtained both locally and from the regional cancer registry. All lesions were graded using both the 3‐tier and the binary systems. Kaplan–Meier curves (Log‐rank Mantel‐Cox) were used to assess risk and kappa to assess interobserver agreement. Results: Thirty‐five individuals underwent MT (4%). Both systems demonstrated prognostic value, though the 3‐tier system proved superior, with OR 9.23 (3.42–23.69), PPV 0.152, NPV 0.98, compared to binary OR 3.49 (1.79–6.79), PPV 0.079, NPV 0.976. Interobserver agreement was also superior in the 3‐tier system (0.47, p < 0.05) compared to the binary system (0.139, p = 0.39). Combining the two systems enhanced prognostic values (OR 14.28, PPV 0.217, NPV 0.981). Conclusion: The 3‐tier system presented superior prognostic value to the binary system. Combining both systems to double‐grade intermediate lesions might enhance risk assessment. [ABSTRACT FROM AUTHOR]

Aim: To retrospectively evaluate the histopathological characteristics of biopsies taken from tongue lesions and compare the results with current literature. Material and Methods: Histopathological results of biopsies taken from 163 patients with suspected tongue lesions between January 2017 and January 2022 were retrospectively reviewed. The results were evaluated in different age groups. Results: Seventy-two (44.2%) of the patients were male and 91 (55.8%) were female. The mean age of the patients was 47.76±17.33 years. The lesion was benign in 135 (82.8%) patients, precancerous in 4 (2.5%), and malignant in 24 (14.7%). Of the 135 patients with benign findings, squamous papilloma was detected in 33 (24.4%) patients and irritation fibroma in 19 (14.1%). Ulcer/inflammatory granulation tissue was detected in 18 (13.3%) patients, parakeratosis/acanthosis in 14 (10.4%), fibroepithelial polyp in 14 (10.4%), and pseudoepitheliomatous hyperplasia in 9 (6.7%). Less frequently, lymphoid hyperplasia, neurofibroma, mucocele, and verruca vulgaris were detected in 1 (0.7%) patient each. Squamous cell carcinoma was detected in all patients with malignancy. When evaluated according to age groups, it was found that the patients were most commonly in the 50-59 (27.6%) age group, followed by the 40-49 (19.6%) age group. Conclusion: The results show that most tongue lesions are benign. It should be noted that not every mass in the tongue is cancerous, but leukoplakic and ulcerated areas can be malignant. Due to the rapid metastasis of tongue lesions, early diagnosis and treatment may contribute significantly to the prognosis of patients. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the density of the dendritic cells (DCs) and macrophages in oral leukoplakia (OL) and proliferative verrucous leukoplakia (PVL) by immunohistochemical analysis. We analysed paraffined tissue samples of PVL (n = 27), OL (n = 20), and inflammatory fibrous hyperplasia (n = 20) as the control group using the immunomarkers for DCs (CD1a, CD207, CD83, CD208 and CD123) and macrophages (CD68, CD163, FXIIIa and CD209). A quantitative analysis of positive cells in the epithelial and subepithelial areas was determined. Our results showed a reduction in CD208+ cells in the subepithelial area of the OL and PVL compared to the control. Additionally, we found a higher density of FXIIIa+ and CD163+ cells in the subepithelial area in PVL compared to the OL and control. Four-way MANOVA revealed a relationship between increased CD123+ cell density in the subepithelial area of "high-risk" samples regardless of disease. Macrophages provide the first line of defence against PVL antigens, suggesting a distinct pattern of innate immune system activation in PVL compared to OL, which may contribute to the complexity and the high rate of malignant transformation in the PVL. [ABSTRACT FROM AUTHOR]

Objectives: To identify possible associations between patients' demographics and habits and the clinical aspects and histopathological characteristics of oral leukoplakia (OL) at patients' first visit. Method: A total of 140 consecutive patients with OL at a single institute between 1997 and 2019. All biopsies were microscopically examined for classic dysplasia (CD) (WHO definition oral epithelial dysplasia) and differentiated dysplasia (DD) known from differentiated vulvar intraepithelial neoplasia. Clinical characteristics were correlated to histopathological diagnosis and odds ratios (OR) were calculated. Results: A total of 96 females and 44 males, mean age 58 years, were presented. OLs were found mainly on the tongue (41%) and floor of mouth (FOM) (18%). Homogeneous OLs (58%) were associated with smoking, FOM and size <2cm and non‐homogeneous OLs (42%) with non‐smokers. No dysplasia was present in 40% and any dysplasia (AD) in 60%. Tongue OLs were correlated with AD (OR:6.0) and CD (OR:5.7). FOM OLs were correlated with CD (OR:4.5). DD was correlated with non‐homogeneous OLs (OR:2.6). Conclusions: CD was most frequently observed in tongue and FOM OLs, while DD was associated with non‐homogeneous OLs. In this series of patients, there was no consistent reliable association between the clinical and histopathological features and clinical characteristics can therefore not substitute microscopic examination of biopsies. [ABSTRACT FROM AUTHOR]

Free radicals define oxidative stress as the condition in which the body's antioxidant repair systems cannot keep up with the rate of cell oxidation. Oxidative stress and reactive oxygen species (free radicals) work together to damage cellular components, encourage cell neoplastic transformation, and actively affect all three stages of carcinogenesis. The most prevalent potentially cancerous conditions on the Indian subcontinent are leukoplakia and oral submucous fibrosis, which are mostly brought on by cigarette use and areca nut consumption. Assessment of 8-OHDG, SOD, and GPx levels in saliva of OPMD and OSCC patients with and without diabetes mellitus. ELISA ASSAY was used for finding the levels of 8-OHDG, SOD, and GPx. Add salivary samples and diluent 40 µL into the testing sample. Then add some 10 µL sample into the testing sample well, Cover it properly, and incubate for some 45 minutes at 37 °C. Aspirate each well and wash, repeat the process four times for a total of five washes, 1-3 minutes per time. HRP-conjugated detection antibody is added to each well. This study is one of the first attempts to find the Assessment of 8-OHDG, SOD, and GPx levels in the saliva of OPMD and OSCC patients with and without diabetes mellitus. [ABSTRACT FROM AUTHOR]

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Oral leukoplakia (OL) and proliferative verrucous leukoplakia (PVL) are oral potentially malignant disorders (OPMDs) that microscopically show no or varying degrees of dysplasia. Even sharing clinical and microscopic aspects, PVL shows a more aggressive clinical behaviour, with a malignant transformation rate greater than 40%. Inflammatory infiltrate associated with dysplastic lesions may favour malignant transformation of OPMDs. This study aimed to evaluate the density of T cells and cytokines in dysplastic lesions from OL and PVL patients. Additionally, we evaluated whether soluble products produced in vitro by dysplastic keratinocytes are capable of modulating apoptosis rates and Th phenotype (Th1, Th2, Th17 and Treg) of peripheral blood mononuclear cells. The density of CD3, CD4 and CD8 T cells was assessed by immunohistochemistry. Cytokines and chemokines profile from frozen tissue samples were analysed using the LUMINEX system. Apoptosis rates and Th phenotype modulation were evaluated by flow cytometry. Our results showed an increase in the number of CD8 T cell in the subepithelial region from PVL dysplastic lesions in relation to OL samples. PVL showed increased levels of IL‐5 and a decrease in IL‐1β and IFN‐γ levels compared to OL. Soluble products of PVL and oral carcinoma cell cultures were able to reduce apoptosis rate and promote an imbalance of Th1/Th2 and Th17/Treg. The high‐subepithelial density of CD8 T cells and immune imbalance of T lymphocytes subsets probably play an important role in the pathogenesis of PVL and may explain its more aggressive behaviour in relation to OL. [ABSTRACT FROM AUTHOR]

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Oral leukoplakia (OL), an oral potentially malignant disorder, begins with a hyperplastic/hyperkeratotic stage at which no genome-scale somatic single nucleotide variant profiles have been described so far. We performed exome sequencing of five cases at this stage with no evidence of dysplasia to identify genetic alterations (exon-level copy number alterations, indels, and single nucleotide variants), their association with transcript levels, and relationship with oral cancer susceptibility. Pathway enrichment analysis of genes associated with tobacco chewing and age-related mutation signatures, transcripts with variants predicted to be functionally damaging and those with significantly altered levels all indicated the involvement of focal adhesion, ECM-receptor interactions, regulation of cytoskeleton, and DNA repair. Two novel mutations identified in FAT1 tumor suppressor gene were associated with decreased transcript levels. In addition, 16 expressed cancer driver genes contained functionally damaging variants. Many of the affected genes were also reported in dysplastic OL lesions. The presence of variants in cancer driver genes and those shared with oral dysplasias possibly provides a basis for further progression and increased susceptibility to oral cancer. [ABSTRACT FROM AUTHOR]

Background: Leukoplakia is an asymptomatic, potentially malignant lesion in the oral mucosa which often develops into oral cancer. Various follow-up studies done show that between <1 and 18% of oral pre-malignant lesions will develop into oral cancer. Periodontitis is related to different pathological states in the oral cavity including pre-malignant and malignant lesions. Frequently, periodontal sites are involved in proliferative types of leukoplakia. Therefore, Periodontitis increases the risk of oral leukoplakia and, therefore, the risk of mucosal lesions predisposing to oral cancers. Methods: A 39 year old male patient reported to the Department Of Periodontology with chief complaint of bleeding of gums and whitish patch on his right and left buccal mucosa since 6 months. A Complete clinical examination and detailed case history was recorded for the same. Proper treatment plan was planned and implemented. This cased showed a strong corelation between periodontitis and oral leukoplakia. Conclusion: Poor oral hygiene and the ensuing of plaque accumulation results in a chronic inflammatory process, creating an environment that promotes the development premalignant lesions and oral carcinoma. Our study supports the hypothesis that periodontitis is an individual risk factor for Oral premalignant lesions. Periodontal disease is a chronic inflammatory condition that may be prevented with regular dental visits and with the maintenance of the Oral hygiene. Dentists play an important role in preventing oral cancer by evaluating the socioeconomic status of each patient and appraising their lifestyle and habits. Therefore this case report mainly focuses on interrelationship between maintenance of good periodontal health and development of oral premalignant lesions. [ABSTRACT FROM AUTHOR]

Introduction: The role of E-cadherin and CD44 has been proven in the development and progression of cancerous and precancerous lesions. It seems that these two markers have a high ability to evaluate the premalignancy of lichen planus lesions and oral leukoplakia. This study aimed to investigate and compare the expression of CD44 and E-cadherin markers in oral leukoplakia, lichen planus, and oral squamous cell carcinoma (SCC). Material & Methods: This analytical-descriptive study was conducted on 60 blocks of lichen planus, leukoplakia, and squamous cell carcinoma. The blocks were stained by CD44 and E-cadherin antibodies. The obtained data were analyzed in SPSS software (version 22), and a P-value of 0.05 was considered statistically significant. Findings: Only 30% of the SCC samples expressed the CD44 marker, while 40% and 50% of leukoplakia and lichen planus samples expressed the CD44 marker, respectively. The expression of the E-cadherin marker in SCC samples was 40% in the range of staining, while it was 50% and 60% in leukoplakia and lichen planus, respectively. There was not a significant difference between the staining intensity of CD44 and E-cadherin (P<0.16). However, in SCC, 70% of the cases showed mild to moderate expression intensity that was statistically significant, compared to lichen planus and leukoplakia (P<0.004). Discussion & Conclusion: It seems that the severity of CD44 and E-cadherin incidence can indicate the changes in dysplasia and premalignancy of oral lichen planus and leukoplakia, compared to oral carcinomas. [ABSTRACT FROM AUTHOR]

Objectives: Our main purpose and research question were to analyze and quantify whether there were significant differences in the time to develop cancer among patients with oral leukoplakia (OL), comparing the more susceptible cases to those with the least susceptibility to malignancy. Materials and methods: We followed 224 cases of OL after surgical or CO2 laser treatment for a mean time of 6.4 years. A Bayesian mixture cure model based on the Weibull distribution was used to model the relationship between our variables and cancer risk. In this model type, the population is considered a mixture of individuals who are susceptible or non-susceptible to developing cancer. The statistical model estimates the probability of cure (incidence model) and then infers the time to malignancy. The model was adjusted using the R-package INLA using default priors. Results: Histology type (moderate or severe dysplasia) and tongue location showed hazard ratios (HR) of 3.19 (95% CI [1.05–8.59]) and 4.78 (95% CI [1.6–16.61]), respectively. Both variables increased the risk of malignant transformation, thus identifying a susceptible subpopulation with reduced time required to develop cancer, as with non-homogeneous leukoplakias. The median time for cancer development was 4 years and 5 months, with a minimum of 9 months after the diagnosis of OL and a maximum of 15 years and 2 months. Conclusions: Susceptible patients with non-homogeneous leukoplakia, dysplasia, or leukoplakia in the tongue develop cancer earlier than those with homogeneous OL and those without dysplasia. Clinical relevance: The novel contribution of this research is that, until now, the time it took for oral leukoplakias to develop cancer based on whether they were homogeneous or non-homogeneous, and if they have or not epithelial dysplasia, had not been comparatively described and quantified. As a final result, the time to malignant transformation in non-homogeneous and dysplastic leukoplakias is significantly shorter. [ABSTRACT FROM AUTHOR]

Context and Aim: Oral leukoplakia has recently been re-defined as "a predominantly white lesion of the oral mucosa that cannot be characterised as any other definable lesion". Superoxide dismutase (SOD) is one of the enzymatic anti-oxidants which form the first line of defence in the cell. There are very limited data available on the analysis of SOD in leukoplakia patients. Therefore, the present study was planned to analyse anti-oxidant SOD levels in leukoplakia patients. Methods and Material: The study group consisted of 29 subjects of oral leukoplakia, and the control group consisted of 25 healthy individuals. All the subjects were evaluated for SOD enzyme in plasma. Statistical Analysis Used: The results for each determinant were calculated using one-way ANOVA test, Student 't' test, Pearson Chi square test, and 't' test for equality of means wherever applicable. Results: The study revealed that among the different clinical entities of oral leukoplakia, the enzymatic anti-oxidant SOD is shown to have decreased in all forms of oral leukoplakia, but without any statistical significance. A statistically highly significant decrease (at P < 0.0001) of SOD in oral leukoplakia patients compared to normal healthy patients was observed in the present study. Conclusions: The study revealed a difference in the free-radical activity and oxidative stress in blood of leukoplakia patients compared to healthy patients, which is reflected by the variation in the levels of blood SOD, thus showing vulnerability to cellular damage and tendency towards further malignant changes. [ABSTRACT FROM AUTHOR]

Oral proliferative verrucous leukoplakia (OPVL) is a rare form of oral leukoplakia first reported in 1985. It is a longterm progressive condition, which develops initially as a white plaque of hyperkeratosis that eventually becomes a multifocal disease with confluent, exophytic, and proliferative features. It has no racial preference with female predilection, associated with various factors including human papillomavirus (HPV) association, genetic susceptibility, and long-standing low-grade traumatic factors. The malignancy transformation rate varies from 0.13 to 17.5% with frequent recurrences. Here, we have reported two cases of PVL seen over the tongue and palate. It is confirmed by clinical and histopathological features and treated with Vitamin A and its supplements and a long-term follow-up showed no recurrence, and hence, Vitamin A has proven as a potent treatment option of PVL by its antioxidant and epithelialization property. [ABSTRACT FROM AUTHOR]

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Introduction: Human papillomavirus (HPV) infection is mainly a problem of the female reproductive tract. It can occur in the oral cavity as well. Commonly HPV infections are subclinical, without any visible symptoms, and last no longer than 2 years. Usually the clinical manifestation of HPV infection is benign, but in some cases it can also promote malignant transformation. In the paper we have tried to estimate the prevalence of HPV detected in samples of oral leukoplakia (OLK), the most common premalignant lesions of the oral mucosa. Aim: To review the current literature to estimate the prevalence of HPV (HPV DNA) detected in samples of oral leukoplakia. Material and methods: We searched PubMed/Medline, Scopus, and Cochrane Library databases for studies that examined the prevalence of HPV in leukoplakia with HPV DNA detection by polymerase chain reaction. Results: HPV positive cases in OLK ranged from 0% to 100% in studies. The overall HPV prevalence in leukoplakia was 6.66%. The prevalence of HPV 16 positive cases was 2.95%. The high-risk HPV prevalence was 5.16%, when the low-risk HPV prevalence was 3.32%. When dysplasia is mentioned, HPV was detected in 19.56% of lesions with dysplasia, compared to 38.16% among non-dysplastic lesions. Conclusions: Further studies should be extended also to include low-risk HPV and compare its prevalence with presence of dysplasia in leukoplakia. Besides, leukoplakia and other premalignant lesions can no longer be treated as one lesion. [ABSTRACT FROM AUTHOR]

Among oral diseases, oral cancer is a critical health issue due to its life-threatening potential. Globocan, in its 2020 report, estimated ∼0.37 million new cases of oral cancer, with the majority of them coming from the Asian continent. The WHO has anticipated a rise in the incidences of oral cancer in the coming decades. Various factors, such as genetic, epigenetic, microbial, habitual, and lifestyle factors, are closely associated with oral cancer occurrence and progression. Oral lesions, inherited genetic mutations (dyskeratosis congenital syndrome), and viral infections (HPV) are early signs of oral cancer. Lesions with dysplastic features have been categorized under oral potentially malignant disorders (OPMDs), such as oral leukoplakia, erythroplakia, oral submucous fibrosis (OSMF), and proliferative verrucous leukoplakia, are assumed to have a high risk of malignancy. The incidence and prevalence of OPMDs are recorded as being high in South-Asian countries. Early detection, prevention, and treatment of OPMDs are needed to prevent its malignant transformation into oral cancer. Many advanced diagnostic techniques are used to predict their progression and to assess the risk of malignant transformation. This communication provides insight into the importance of early detection and prevention of OPMDs. (A) A representative diagram of changes occurring in buccal mucosa due to exposure to various carcinogenic factors. The red arrow shows the direction of changes associated with the progression of oral cancer. (B) The circular map shows the chromosomes involve in genetic alternation. [ABSTRACT FROM AUTHOR]

Oral leukoplakia is a potentially malignant disorder, defined as a white plaque that cannot be diagnosed as another known disease or disorder, and has an increased risk of malignancy. The aim of the present study was to evaluate the results of CO2 laser treatment in a well-defined cohort of patients with oral leukoplakia in order to identify the occurrence of clinical outcomes of relapse, resolution, or malignancy after treatment. The study group comprised 37 patients. Before treatment, clinical photographs and incisional biopsies were obtained in all cases. In addition, the post-treatment results were documented using photographs. Evaluation of treatment results was performed by an independent researcher who had not performed the surgery. The minimum, maximum, and mean values of continuous variables were calculated. Statistically significant relationships were tested using the Cox regression analysis. A survival curve was constructed according to the Kaplan-Meier method to analyze the malignant transformation and recurrence of oral leukoplakia. The clinical outcomes analyzed were resolution, recurrence, and malignancy. The mean follow-up period was 36 months (range, 6-239 months). In 13/37 patients, leukoplakia recurred between 6 and 93 months (mean, 38.2 months). In 8/37 patients, a malignant transformation occurred (mean, 50.6 months). In 16/37 patients, lesion resolution occurred. No risk factor was statistically significant for malignancy or recurrence of lesions. The treatment of the lesions by CO2 laser was efficient in the removal of the lesions; however, it did not avoid the clinical outcomes of recurrence or malignancy. [ABSTRACT FROM AUTHOR]

Introduction: Oral leukoplakia has an estimated prevalence of 2% of the oral cavity, one of the risk factors for oral cancers. The most commonly linked etiology being tobacco smoking causing reactive oxygen species (ROS) induced DNA damage. Curcumin, a polyphenol derivative from herbal remedy, possesses diverse properties ranging from centuries old documented anti-inflammatory properties to recently documented anticancer properties. Aims: Role of nano curcumin on superoxide dismutase (SOD) levels in leukoplakia patients' pre- and post-treatment. Materials and Methods: The study group comprised thirty test subjects. Single capsule of 250 mg (Brecan Plus) was given to the test group for 30 days with weekly follow-up. Blood samples were taken from the test group and were evaluated for SOD levels before and after the completion of the trial. Results: In the study, there was a decrease in size of the lesion, number of lesions, down staging of the disease, and increase in serum SOD levels after the therapy. Binary logistic retrogression analysis was done to assess the predictive ability of serum SOD-dependent variable, and a positive association was noted between increase in serum SOD level and down staging of the disease. Conclusion: Nano curcumin is an excellent medical nutrition intervention derived from traditional natural products. The study has demonstrated the clinical efficacy of these new classes of therapeutic nutraceuticals such as nanocurcumin in treating oral leukoplakia, which are suitable for long-term use. [ABSTRACT FROM AUTHOR]

Objective: While some oral carcinomas appear to arise de novo, others develop within long-standing conditions of the oral cavity that have malignant potential, now known as oral potentially malignant disorders (OPMDs). The oral bacteriome associated with OPMD has been studied to a lesser extent than that associated with oral cancer. To characterize the association in detail we compared the bacteriome in whole mouth fluid (WMF) in patients with oral leukoplakia, oral cancer and healthy controls. Methods: WMF bacteriome from 20 leukoplakia patients, 31 patients with oral cancer and 23 healthy controls were profiled using the Illumina MiSeq platform. Sequencing reads were processed using DADA2, and taxonomical classification was performed using the phylogenetic placement method. Sparse Partial Least Squares Regression Discriminant Analysis model was used to identify bacterial taxa that best discriminate the studied groups. Results: We found considerable overlap between the WMF bacteriome of leukoplakia and oral cancer while a clearer separation between healthy controls and the former two disorders was observed. Specifically, the separation was attributed to 14 taxa belonging to the genera Megaspheara, unclassified enterobacteria, Prevotella, Porphyromonas, Rothia and Salmonella, Streptococcus, and Fusobacterium. The most discriminative bacterial genera between leukoplakia and oral cancer were Megasphaera, unclassified Enterobacteriae, Salmonella and Prevotella. Conclusion: Oral bacteria may play a role in the early stages of oral carcinogenesis as a dysbiotic bacteriome is associated with oral leukoplakia and this resembles that of oral cancer more than healthy controls. Our findings may have implications for developing oral cancer prevention strategies targeting early microbial drivers of oral carcinogenesis. [ABSTRACT FROM AUTHOR]

Dyskeratosis congenita is a rare inherited bone marrow failure syndrome with three distinct clinical features: nail dystrophy, reticular skin pigmentation, and oral leukoplakia. The case of a 5-year-old female patient diagnosed with squamous cell carcinoma of the tongue is reported here. An autosomal dominant type 3 TINF2 mutation subsequently confirmed the diagnosis of dyskeratosis congenita. The traditional tongue cancer treatment was adapted for this young patient. While the tongue cancer lesions and leukoplakia were removed, the deep margins were minimized to preserve the tongue muscles and flap surgery was avoided. Additional conservative measures were applied to suppress new leukoplakia lesions. [ABSTRACT FROM AUTHOR]

Background: Oral squamous cell carcinoma is the most common form of head and neck cancer which is sometimes preceded by potentially malignant disorders such as leukoplakia. Oral leukoplakia is a potentially malignant lesion that has been considered to confer increased risk for the development of oral cancer. Tobacco smoking and alcohol intake have been attributed as major risk factors. Many articles were published connecting the malignant transformation rate to lifestyle modifications. As contemporary sources of information regarding malignant transformation rate of oral leukoplakia are lacking, there is a need to have a comprehensive evaluation of leukoplakia and its malignant transformation potential. Aim: This study aims to provide a systematic review of research on the current malignant transformation rate of oral leukoplakia. Objective: To find association between malignant transformation rate and other parameters in oral leukoplakia. Results: The malignant transformation rate of oral leukoplakia was observed to be 5.7% from the year 1963 and has increased by two-fold from year 1996 to 10.9%. Malignant transformation rate of verrucous leukoplakia was 28.2%. Dysplastic malignant transformation rate of leukoplakia was 53.7% [95% Confidential interval: 32.9%, 74.5%] overall malignant transformation rate of oral leukoplakia was 10.9%. Conclusion: The two-fold increase in the malignant transformation rate since 1990s should be considered as an alarming issue, and necessary steps have to be taken in this regard.