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Interventional laser surgery for oral potentially malignant disorders: a longitudinal patient cohort study

Lookup NU author(s): Dr Michaela Goodson

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Abstract

© 2016 International Association of Oral and Maxillofacial Surgeons Oral squamous cell carcinoma (OSCC) is a lethal disease, with rising incidence. There were 6767 new OSCC cases and 2056 deaths in the UK in 2011. Cancers are preceded by oral potentially malignant disorders (PMDs), recognizable mucosal diseases harbouring increased SCC risk, offering clinicians a ‘therapeutic window’ to intervene. Contemporary practice remains unable to predict lesion behaviour or quantify malignant transformation risk. No clear management guidelines exist and it is unclear from the literature whether early diagnosis and intervention prevents cancer. Between 1996 and 2014, 773 laser treatments were performed on 590 PMD patients in Newcastle maxillofacial surgery departments. The efficacy of the intervention was examined by review of the clinicopathological details and clinical outcomes of the patients (mean follow-up 7.3 years). Histopathology required up-grading in 36.1% on examining excision specimens. Seventy-five percent of patients were disease-free, mostly younger patients with low-grade dysplasia; 9% exhibited persistent disease and were generally older with proliferative verrucous leukoplakia. Disease-free status was less likely for erythroleukoplakia (P = 0.022), ‘high-grade’ dysplasia (P < 0.0001), and with lichenoid inflammation (P = 0.028). Unexpected OSCC was identified in 12.0%, whilst 4.8% transformed to malignancy. Interventional laser surgery facilitates definitive diagnosis and treatment, allows early diagnosis of OSCC, identifies progressive disease, and defines outcome categories. Evidence is lacking that intervention halts carcinogenesis. Multicentre, prospective, randomized controlled trials are needed to confirm the efficacy of surgery.

Publication metadata

Author(s): Thomson PJ, Goodson ML, Cocks K, Turner JE

Publication type: Article

Publication status: Published

Journal: International Journal of Oral and Maxillofacial Surgery

Year: 2017

Volume: 46

Issue: 3

Pages: 337-342

Print publication date: 01/03/2017

Online publication date: 17/11/2016

Acceptance date: 02/11/2016

ISSN (print): 0901-5027

ISSN (electronic): 1399-0020

Publisher: Churchill Livingstone

URL: http://doi.org/10.1016/j.ijom.2016.11.001

DOI: 10.1016/j.ijom.2016.11.001

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