Premalignant lesion of oral cavity with most potential to malignancy?
Correct Answer: Erythroplakia
Description: ANSWER: (B) ErythroplakiaREF: Bailey 25th ed page 735 Box46.2, Dhingra 4th ed page 209, Robbins 8th ed chapter 16, Das text book of surgery 3rd edition page 104, Rooks Textbook of Dermatology 4th Volume 8th ed page 52.29-52.37The term leukoplakia is defined by the World Health Organization as "a white patch or plaque that cannot be scraped off and cannot be characterized clinically or pathologically as any other disease." Simply put, if a white lesion in the oral cavity can be given a specific diagnosis it is not a leukoplakia.Thls clinical term is reserved for lesions that are present in the oral cavity for no apparent reason. Approximately 3% of the worlds population have leukoplakic lesions, and somewhere between 5% and 25% of these lesions are premalignant. Thus, until it is proved otherwise via histologic evaluation, all leukoplakias must be considered precancerous. The chances of leukoplakia becoming malignant are cited from 1 to 17,5%. On an average about 5% become malignant,Erythroplakia represents a red, velvety, possibly eroded area within the oral cavity that usually remains level with or may be slightly depressed in relation to the surrounding mucosa. It is much less common than leukoplakia. The epithelium in such lesions tends to be markedly atypical, incurring a much higher risk of malignant transformation than that seen with leukoplakia, malignant potential is 17 times ofleukovlakia.Intermediate forms are occasionally encountered that have the characteristics of both leukoplakia and erythroplakia, termed speckled leukoerythroplakia. It has the highest rate of malignant transformation. (Bailey)Submucous fibrosis is a condition found particularly in those of South Asian extraction, and is thought to be a tanning of the oral mucous membrane induced by betel-quid chewing. Malignant transformation has been seen in 3-7.6% of cases.PREMALIGNANT CONDITIONSOral CavitySkinPenisHigh risk:* Erythroplakia* Speckled erythroplakia* Chronic hyperplastic candidiasis (Candidial leukoplakia)* Leukoplakia* Bowen's disease* Senile keratosis* Solar/actinic keratosis* Arsenical keratosis* Post-ionizing radiation keratoses* Tar keratoses* Xeroderma pigmentosa* Long standing chronic ulcer* Lupus vulgaris* Oncogenic HPV (HPV 16 and HPV 18)* Leukoplakia* Erythroplasia of Queyrat (Bowen disease of the glans penis)* Bowenoid papillomatosis of the genitalia* Balanitis xerotica obliterans (BXO) AKA- Genital lichen sclerosus et atrophicus, AKA-Lichen sclerosis)* Penile cutaneous horn* Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB)Intermediate risk lesions:* Oral sub mucosal fibrosis* Syphillitic glossitis* Sideropenic dysphagia (Paterson Kelly syndrome)Low-risk/equivocal-risk lesions* Oral lichen planus* Discoid lupus erythematosus* Discoid keratosis congenitaNote:Condylomata acuminatum (Genital wart) caused most commonly by HPV 6 and HPV 11 (called benign HPV types) is not a premalignant conditionIn malignant and premalignant conditions of penis HPV 16 and HPV 18 (so called Oncogenic HPV) are detectedRate of malignant transformation of premalignant lesions of oral cavity are in order of Speckled leukoerythroplakia > Erythroplakia > Candidial leukoplakia > Leukoplakia > Submucous fibrosis
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