Meir Gorsky

Oral leukoplakia and malignant transformation. A follow‐up study of 257 patients

Two hundred fifty‐seven patients with oral leukoplakia were studied and followed for an average period of 7.2 years. All lesions were more than one cm in size and had been present and observed for a minimum of 6 months. Of the initial biopsies, 235 revealed a benign hyperkeratosis and 22 others contained some degree of epithelial dysplasia. Seventy‐three percent of the patients used tobacco, with cigarette usage being the predominant form. Forty‐five patients (17.5%) subsequently developed squamous carcinomas in the hyperkeratotic epithelial site in an average time of 8.1 years. Eight of these malignant transformations came from patients who originally had epithelial dysplasia. High risks for malignant transformation also included non‐smoking patients, the clinical presence of erythroplasia (erythroleukoplakia), and a clinical verrucous‐papillary hyperkeratotic pattern. Duration of the leukoplakia progressively increased the total number of malignant transformations, with the largest rate occurring in the second year. This study confirms that oral leukoplakia is a precancerous lesion and that certain characteristics indicate greater risks and warrant consideration of more aggressive management.

A prospective follow-up study of 570 patients with oral lichen planus: persistence, remission, and malignant association.

Five hundred seventy patients with oral lichen planus were followed for periods ranging from 6 months to more than 10 years (mean, 5.6 years). The mean age was 52 years, and 67% of the patients were women. Erosive lichen planus was the most frequent clinical form, and the buccal mucosa was the most common site. Of the 75% patients treated with corticosteroids, 29% experienced complete remission and 63% had partial remission while maintained on medication. Fewer than 3% experienced spontaneous remission. Malignant transformation occurred in 7 patients (1.2%) in a mean time of 3.4 years after the onset of lichen planus. The onset of lichen planus could not be associated with any evident factors, such as family history, Candida albicans, glucose intolerance, and smoking.

A prospective study of findings and management in 214 patients with oral lichen planus

The findings in this prospective study of 214 patients with oral lichen planus were similar to those found in our 1985 evaluation of 570 patients with oral lichen planus. These two groups of patients with oral lichen planus patients constitute the largest series from one clinic. Oral lichen planus was found mainly in women and most commonly on the buccal mucosa. Spontaneous remissions were infrequent (6.5%), as were malignant transformations (2.3%) in a mean follow-up of 7.5 years. The erosive form of oral lichen planus was most common and was almost always associated with pain. Reproducibly successful management of this T-lymphocyte disease was obtained by selective use of systemic and/or topical corticosteroids. Oral lichen planus was not associated with any evident systemic disease, drug, smoking, or genetic predisposition. Although statistically Candida albicans does not appear to occur disproportionately in large samples of patients with oral lichen planus, in some of the Candida-positive patients, antifungal medications appeared to be useful.

Clinical characteristics and management outcome in the burning mouth syndrome: An open study of 130 patients

Clinical characteristics and treatment responses were studied in 130 patients with burning mouth syndrome (BMS). Most patients were postmenopausal women, and the tongue was the most frequently afflicted site. Although 39% of the patients complained of dry mouth, no causative factors were evident. Therefore BMS is assumed to be a functional disorder. This was at least partially confirmed because the most effective management was in response to mood-altering drugs. From our data BMS appears to be a chronic condition with variations in symptoms among patients and without a predictable endpoint.

Oral lichen planus: Progress in understanding its malignant potential and the implications for clinical management

Oral lichen planus (OLP) is an inflammatory lesion that has malignant potential, but few cases of OLP progress to malignancy. A diagnosis of OLP should be confirmed on the basis of historical, clinical, and histologic data. The presence of dysplasia in an OLP-like lesion increases the risk of malignant transformation, mandating management and close follow-up. A molecular assessment of OLP may provide the best evidence of malignant risk and will likely become available for clinical use. In addition, exfoliated cells may be examined for loss of heterozygosity and may become a valuable clinical tool for patient follow-up. The treatment of OLP should include elimination of tissue irritants and recurring exposure to oral carcinogens. If OLP is symptomatic, appropriate treatment with immunosuppressive medications, particularly corticosteroids, should be undertaken. For lesions with dysplastic changes, management may include attention directed to the inflammatory change and follow-up biopsies to assess residual histologic changes that may represent dysplasia. Dysplastic OLP may be best treated as other oral dysplastic conditions; thus, regular, more frequent follow-up is required.

The correlation between epidermal growth factor levels in saliva and the severity of oral mucositis during oropharyngeal radiation therapy

Epidermal growth factor (EGF) is present in biologic fluids, including saliva, and plays a role in maintenance of the epithelial barrier and in healing of damaged mucosa. The purpose of this study was to assess the relation between salivary EGF and the severity of oral mucositis in patients with carcinoma of the head and neck during radiation therapy.

Burning mouth syndrome and other oral sensory disorders: a unifying hypothesis.

Burning Mouth Syndrome (BMS) is a sensory disorder which results in constant, bilateral burning pain of the tongue, lips, and other oral mucous membranes. Atypical odontalgia (AO) is another sensory disorder, usually defined as a toothache-like pain for which no dental cause can be identified. Previous literature has suggested that AO is often associated with a concomitant temporomandibular disorder (TMD). This hypothesis paper explores the possibility that BMS, AO and TMD can be related through hyperactivity of both the sensory and motor components of the trigeminal nerve following loss of central inhibition as a result of taste damage in the chorda tympani and/or the glossopharyngeal nerves.

Melanoma arising from the mucosal surfaces of the head and neck

Oral mucosal malignant melanoma is a rare disease. We reviewed 30 years of data from a tumor registry and identified 65 patients who had head and neck melanomas. Two thirds (43) of the 65 patients were identified as male, with the mean age in the sixth decade. Of the 65 patients, only 6 had melanoma that arose from the oropharyngeal mucosa. Of the lesions involving the oral mucosa, each lesion manifested itself as a mass or was associated with symptoms of discomfort; only one third (2) of the lesions were pigmented. The clinician must carefully examine the head, neck, and oral cavity, and any pigmented lesion that is not recognized as a specific entity, such as amalgam tattoo, should be biopsied. The more common presentation of amelanotic malignant melanoma requires a high index of suspicion for masses identified in the mouth and requires biopsy for definitive diagnosis. The prognosis for oral mucosal malignant melanoma is poor.

Oral mucous membrane pemphigoid: A study of sixty-five patients

Sixty-five patients with oral mucous membrane pemphigoid were examined, treated, and followed for a mean of 3.5 years. Seventy-two percent were women, and the mean age was 59 years. In most patients multiple oral sites were involved and the gingiva was affected in 94% of the patients. Seven patients had ocular lesions (symblepharon), and seven others had nasal, vaginal, or pharyngeal involvement. Persons with skin lesions (bullous form) were not included in this series. Topical and systemic anti-inflammatory/immunosuppressive medications were successful in controlling signs and symptoms. There were no spontaneous remissions. Candidiasis, tobacco, other diseases, and drugs did not appear to be related to the pemphigoid.

Clinical characteristics and treatment of patients with oral lichen planus in Israel

Oral lichen planus (OLP) has a multiple-site involvement, with the buccal mucosa being the most prevalent. A possible relationship between OLP and the risk of malignancies in the involved site is documented. The characteristics of OLP have been studied in different populations; however, no similar studies have been conducted in any Jewish population. The purpose of this study was to evaluate the natural history of OLP in Israeli Jewish patients. Data were collected from 157 charts of patients with histologically confirmed OLP. No evidence suggesting a connection between OLP and diabetes, cardiovascular disease, smoking, alcohol use, or positive Candida culture was found. Skin involvement of lichen planus was found in one fifth of the patients. Symptomatic OLP was noted in half of the patients, mainly in those with the erosive form. In 65% of the patients with symptoms, improvement by more than 50% was shown within 2 weeks of steroid use. The transformation rate of 1.3% of OLP into malignancy was observed in the entire group. A constant follow-up for contributing symptoms and for early diagnosis of suspected transformed lesions is of utmost importance.