Dysplasia/neoplasia surveillance in oral lichen planus patients: a description of clinical criteria adopted at a single center and their impact on prognosis.

The concept of dysplasia/neoplasia surveillance has been applied to long-standing conditions associated with an increased risk of cancer. Although still controversial, periodic direct clinical examination as well as endoscopic techniques are currently performed in patients with inflammatory bowel diseases, Barrett’s esophagus, and melanocytic skin lesions in order to detect and treat dysplastic or early malignant changes and therefore improve the patients’ prognosis. It is not known if patients with oral lichen planus (OLP), a chronic inflammatory condition associated with an increased risk of cancer development, might benefit from such surveillance as well, nor how this should be performed. Here we present the clinical criteria we have adopted over a 12-year period to detect early malignant transformation of OLP, and report on their impact on the management and prognosis of patients. Overall data from 45 patients affected by 117 neoplastic events arising from OLP have been evaluated. Our dysplasia/ neoplasia surveillance has led us to diagnose most episodes (94.9%; n.: 111) of OLP malignant transformation in early intraepithelial and microinvasive phases, namely stage 0 and I oral cancers (Tis N0M0 or T1N0M0). The 5-year survival rate, where applicable, has been 96.7%. Advanced stage oral cancers have been diagnosed in six patients, three of whom have died. We suggest that the application of strict and rigorous clinical criteria in dysplasia/neoplasia surveillance could help clinicians to detect and treat early OLP malignant transformation and therefore improve long-term survival rates. Nevertheless, a small subgroup of patients has been shown not to benefit from such surveillance and to be characterized by a rapid development of advanced-stage oral carcinomas, with consequent poor prognosis

The diagnosis of burning mouth syndrome represents a challenge for clinicians.

AIMS: To evaluate the occurrence of professional delay in the diagnosis, referral, and treatment of patients with burning mouth syndrome (BMS). METHODS: Fifty-nine patients (51 women and 8 men; average age, 60.5 years; age range, 32 to 88 years) diagnosed with BMS at our institution were retrospectively studied. Data were collected about the onset of oral symptoms, consultations with medical and dental practitioners, and misdiagnosis before definitive BMS diagnosis and treatment. RESULTS: The average delay from the onset of the symptoms to definitive diagnosis was 34 months (range, 1 to 348 months; median, 13 months). The average number of medical and dental practitioners consulted by each patient over this period and who initially misdiagnosed BMS was 3.1 (range, 0 to 12; median, 3). Candidiasis and aspecific stomatitis were the most frequent misinterpretations of the symptoms before appropriate referral. In about 30% of cases, no diagnosis of the oral symptoms was made or explanation given. CONCLUSION: Professional delay in diagnosing, referring, and appropriately. managing BMS patients occurred frequently in the group studied. No significant differences were found in the number of medical and dental practitioners who were consulted. Emphasis must therefore be placed upon educational efforts to improve health care providers' awareness of BMS. This should increase the rate of recognition and appropriate referral or treatment of patients with chronic orofacial pain due to BMS

IMMUNE ACTIVATION AND CHRONIC INFLAMMATION AS THE CAUSE OF MALIGNANCY IN ORAL LICHEN PLANUS: IS THERE ANY EVIDENCE ?

The association of chronicinflammation with a variety of epithelial malignancies has been recognised for centuries. Well established examples include, among many others, oesophageal adenocarcinoma associated with chronic oesophagitis and bowel cancer associated with chronic inflammatory bowel diseases. By now no data, other than clinical observation, have been available in understanding the pathogenesis of these inflammation-related tumours. However, recent molecular studies on the relationship between solid malignancies and the surrounding stroma have given new insights. There is now enough evidence to accept that the chronic inflammatory process per se is able to provide a cytokine-based microenvironment which is able to influence cell survival, growth, proliferation, differentiation and movement, hence contributing to cancer initiation, progression, invasion and metastasis. Here it is discussed whether also orallichen planus (OLP), being a chronic inflammatory autoimmune disease which has been clinically associated with development of oral squamous cell carcinoma, might be categorised among these disorders. With this aim, we critically reviewed and detailed the presence, in OLP subepithelial infiltrate, of inflammatory cells and cytokine networks that might act to promote squamous tumorigenesis