J Bagan

Proliferative verrucous leukoplakia: a concise update.

Proliferative verrucous leukoplakia (PVL) is of uncertain etiology but may be associated with human papillomavirus (HPV) infection. Proliferative verrucous leukoplakia is seen mainly in older women, beginning as a simple slow-growing, persistent leukoplakia that tends to spread and become multifocal and affect the gingival frequently. In time, PVL develops exophytic, wart-like or erythroplakic areas that become squamous carcinomas. Proliferative verrucous leukoplakia appears to resist to all attempts at therapy and often recurs.

Urban legends series: oral leukoplakia.

To date, the term oral leukoplakia (OL) should be used to recognize predominantly white plaques of questionable risk, having excluded (other) known diseases or disorders that carry no increased risk of cancer. In this review, we addressed four controversial topics regarding oral leukoplakias (OLs): (i) Do tobacco and alcohol cause OLs?, (ii) What percentage of OLs transform into oral squamous cell carcinoma (OSCC)?, (iii) Can we distinguish between premalignant and innocent OLs?, and (iv) Is proliferative verrucous leukoplakia (PVL) a specific entity or just a form of multifocal leukoplakia? Results of extensive literature search suggest that (i) no definitive evidence for direct causal relationship between smoked tobacco and alcohol as causative factors of OLs, (ii and iii) the vast majority of OLs follow a benign course and do not progress into a cancer, and no widely accepted and/or validated clinical and/or biological factors can predict malignant transformation, and (iv) the distinction between multifocal/multiple leukoplakias and PVL in their early presentation is impossible; the temporal clinical progression and the high rate of recurrences and development of cancer of PVL are the most reliable features for diagnosis.

Medication‐related osteonecrosis of the jaw associated with bisphosphonates and denosumab in osteoporosis

OBJECTIVEnTo describe the clinical characteristics and evolution of our series of medication-related osteonecrosis of the jaws (MRONJ) associated with denosumab in osteoporotic patients.nnnMATERIAL AND METHODSnWe present 10 new cases of MRONJ in patients receiving denosumab for osteoporosis. We describe the mean doses of denosumab, previous bisphosphonate intake, and the clinical characteristics associated with the osteonecrosis, such as local contributing factors, symptoms, and evolution after treatment.nnnRESULTSnThe mean number of denosumab doses was 3.4xa0±xa02.2. In 90% of patients, there was a prior history of oral bisphosphonate intake, with a mean duration of 46.78xa0±xa025.11xa0months. The most common local factor was dental extraction (6 cases; 60%), and most cases had necrotic bone exposure (9/10, 90%). Sclerosis of the bone was the most common radiographic finding. Stage 1 was the most common ONM stage, found in 80%. Cure after conservative treatments was obtained in 71.4%.nnnCONCLUSIONSnMost of our cases were in the early stages of MRONJ, and the success rate after conservative treatment was high.

Complement activation product C4d in oral and oropharyngeal squamous cell carcinoma.

OBJECTIVEnComplement C4d-containing fragments have been proposed as diagnostic markers for lung cancer. The purpose of this study was to evaluate the presence of C4d in oropharyngeal (OPSCC) and oral (OSCC) squamous cell carcinomas.nnnSUBJECTS AND METHODSnC4d staining was analyzed by immunohistochemistry in 244 OPSCC surgical specimens. C4d levels were quantified by ELISA in resting saliva samples from 48 patients with oral leukoplakia and 62 with OSCC. Plasma samples from 21 patients with leukoplakia and 30 with oral carcinoma were also studied.nnnRESULTSnC4d staining in OPSCC specimens was associated with nodal invasion (P = 0.001), histopathologic grade (P = 0.014), disease stage (P = 0.040), and focal-adhesion kinase expression (P < 0.001). No association was found between C4d and prognosis. Saliva C4d levels were higher in patients with oral cancer than in subjects with leukoplakia (0.07 ± 0.07 vs 0.04 ± 0.03 μg ml(-1) , P = 0.003). The area under the ROC curve was 0.63 (95%CI: 0.55-0.71). Salivary C4d levels in stage IV patients were higher than in patients with earlier stages (P = 0.028) and correlated with tumor size (P = 0.045). Plasma C4d levels also correlated with salivary C4d levels (P = 0.041), but differences between patients with oral cancer and subjects with leukoplakia were not significant (1.26 ± 0.59 vs 1.09 ± 0.39 μg ml(-1) , P = 0.232).nnnCONCLUSIONnC4d-containing fragments are detected in oral primary tumors and are increased in saliva from patients with OSCC.

Interleukin-6 concentration changes in plasma and saliva in bisphosphonate-related osteonecrosis of the jaws

AIMnTo determine the plasma and saliva levels of IL-6 in patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) and to investigate whether there is a correlation between more advanced stages of BRONJ and levels of IL-6.nnnMATERIAL AND METHODSnWe studied three groups: group 1 consisted of 30 patients with BRONJ due to intravenous bisphosphonates (ivBP), group 2 consisted of 25 patients treated with ivBP but without BRONJ, and group 3 consisted of 15 healthy controls. In each case, we assayed plasma and saliva IL-6 samples using an ELISA test.nnnRESULTSnSignificantly, higher IL-6 values were found in both saliva and plasma in group 1 vs groups 2 and 3 (Pxa0<xa00.01). Group 1 showed no differences in plasma or saliva IL-6 according to patient gender (Pxa0>xa00.05), type of tumor, BRONJ location, etiology of BRONJ, or disease stage (Pxa0>xa00.05). We found higher plasma and saliva IL-6 values in the more advances stages of BRONJ, although the differences were not statistically significant.nnnCONCLUSIONSnPlasma and saliva IL-6 values were higher in our patients with BRONJ than in controls and therefore might be a useful tool for monitoring the severity of BRONJ.

Oral mucous membrane pemphigoid: A clinical study of 100 low-risk cases

OBJECTIVEnTo analyze the severity of the oral lesions in low-risk oral mucous membrane pemphigoid (OMMP) measured according to the size of the bullous areas and the number of simultaneously affected oral locations.nnnMATERIAL AND METHODSnA total of 100 cases of low-risk OMMP were studied. The symptoms and location of OMMP in the oral cavity were analyzed. The bullous areas were measured, establishing three grades according to the greatest bullous lesion size (grade 1: < 3xa0cm in size; grade 2: 3-6xa0cm; and grade 3: > 6xa0cm).nnnRESULTSnThe mean age of the patients was 66.07xa0±xa013.55xa0years, with a clear predominance of females (84%). Desquamative gingivitis was the most common presentation (97%). A single oral location was found in 67% of the cases, two in 18% and three in 15%. The most common presentation corresponded to grade 1 (the greatest bullous lesion size < 3xa0cm; 51.6% of the cases).nnnCONCLUSIONSnMost cases of low-risk OMMP are restricted to a single site in the oral cavity, the gingiva being the most common location-the predominant grade corresponding to the greatest bullous lesion size < 3xa0cm.