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News Bulletin : ADA News Bulletin September 2011
20 SePtember 2011 committee report It is different if the patient is recurrently biting the lesion. Then you would commonly see a more firm, whitish surface through reactive hyperplasia and keratinisation as a protective mechanism. Usually, this is not a problem. However, chronic mechanical irritation may at some stage lead to dysplasia and finally the possibility of malignant growth. Therefore, it is usually recommended to surgically remove these polyps. The additional benefit for patients would be to no longer have this sometimes painful biting trauma. LESIOnS nOT EASILY CLASSIfIEd Treatment becomes more difficult when practitioners find lesions that cannot be easily classified during clinical examination. Commonly found are white alterations of the mucosa with more or less pronounced findings regarding distribution and surface alterations. A classic lesion of this type is leukoplakia, which means a ‘white spot’ that can’t be classified otherwise (Fig 3). Therefore, it would be an exclusion diagnosis if no other entity could be identified. Fig 5. Squamous cell carcinoma. Fig 4. Lichen ruber planus. Fig 3. Leukoplakia. did the right thing and referred the patient for assessment of the lesion. An excision biopsy revealed this to be a squamous cell cancer (similar size to Fig 5, which shows SCC of mucosa mandible). A wider excision was performed after established diagnosis. However, this treatment is fairly easy and of very limited invasive character compared to a comprehensive treatment in case of advanced cancer development. COnCLUSIOn One case of an early detected cancer, that can be removed with only minor surgery, easily justifies the other ones that do not show any dysplasia in histological examination. Therefore, it is recommended that you should refer patients for a biopsy where you see the possibility of cancer. Many cases, where biopsies are performed, turn out to be ‘negative’, which means positive for the patient, as there is no malignancy found. These are done to find the early cases of cancer, that can be treated successfully with just limited surgery. Paul Hammans Oral and Maxillofacial Surgeon On behalf of the Oral Health Committee dISCLAIMER The statements made in the above article are published on the authority of the author and have not been peer-reviewed. They do not necessarily reflect the views of the ADA and publishing them is not to be regarded as an endorsement of them by the ADA. “...it is important to have a practical approach to handling oral lesions...” Another common lesion is Lichen ruber planus (Fig 4), typically characterised by reticular white lines, often with reddened areas in between. Usually, with more reddening of those lesions there is a higher likelihood of dysplasia and an increased risk for cancer development. However, it is not clearly related and histology may reveal dysplasia of clinically not very suspicious lesions. On the other hand, clinically suspicious lesions may not have any major dysplasia. In these cases, a histological examination is necessary for valid assessment of these lesions. Very recently I saw a patient where things went right. The dentist realised a lesion on the lateral border of the tongue, that appeared as a fairly small ulcer with induration of surrounding tissues. He
ADA News Bulletin August 2011
ADA News Bulletin October 2011