Oral Precancer

ABSTRACT
Context: Tissue eosinophilia in oral squamous cell carcinoma has been
well - recognized. Studies have reported both favorable and unfavorable
prognoses associated with tissue eosinophils in oral squamous cell carcinoma.
However, the role of eosinophils in the development of tumor is still unclear.
Aims: The present study was an attempt to elucidate the potential role
of tissue eosinophils in oral leukoplakia, a potentially malignant lesion.
Settings and Design: To count eosinophils in tissues of normal subjects
and oral leukoplakia cases. To compare tissue eosinophil count (TEC)
between normal and oral leukoplakia cases. To compare TEC between
dysplastic and non-dysplastic cases of oral leukoplakia and to correlate with
degree of epithelial dysplasia. Materials and Methods: A total of 85 cases
(59 cases of oral leukoplakia and 26 normal oral tissues) constituted the
study material. Tissue eosinophils were counted in 10 different high- power
fields. Statistical Analysis Used: Non-parametric tests (Mann-Whitney
U-test, Kruskal-Wallis test, Mann-Whitney post hoc analysis and Spearman’s
correlation statistics).Results: Mean eosinophil count (MEC) in oral leukoplakia
cases was significantly more when compared to normal subjects. MEC in
dysplastic cases of oral leukoplakia was significantly more when compared to
those without epithelial dysplasia (Mann-Whitney U-test). Furthermore, MEC
was directly proportional to the degree of epithelial dysplasia (Spearman’s
correlation statistics). Conclusions: TEC may be used as an adjunct to
predict the malignant transformation of dysplastic cases of oral leukoplakia.
Eosinophilic infiltration in oral dysplastic cases should prompt a thorough
evaluation for invasiveness, especially when features of invasion are absent or
suspected in smaller biopsy specimens. Use of TEC as a prognostic indicator
demands larger sample size and mandates long-term follow-up.
Key words: Eosinophil, epithelial dysplasia, oral leukoplakia

BACKGROUND: Oral cancer is a serious global issue and early diagnosis of oral cancer is the key in reducing the high mortality rate. Autofluorescence properties of oral mucosa have been gaining interest in the field of early diagnosis of oral premalignant lesions.OBJECTIVE: The aim of the study was to evaluate the clinical usefulness of an autofluorescence based imaging system to detect oral premalignant and malignant lesions.MATERIALS AND METHODS: A systematic review of the English-language literature to evaluate the effectiveness of visually enhanced lesion scope (VELscope) published between 1966 and March, 2014 was undertaken. Data relating to study design, sampling and characteristics of the study group, interventions, and reported outcomes and diagnostic value of VELscope were abstracted from articles meeting inclusion and exclusion criteria.RESULTS: Eleven articles that met the inclusion criteria were included. In nine studies, all the lesions underwent histological assessment, whereas the remaining four studies only performed histological assessment on suspicious lesions. Visually enhanced lesion scope showed high sensitivity values in detecting oral premalignant and malignant lesions. However, most of the studies reported it inability in discriminating dysplasia cases from nondysplasia cases.CONCLUSION: There is insufficient evidence to support the use of VELscope in primary care setting, however, they may be useful in hands of a specialist.