Management of oral epithelial dysplasia: a review

published online 26 January 2007.

One of the goals of the fourth meeting of The World Workshop on Oral Medicine (WWOM IV) included a review of the pathophysiology and future directions for the clinical management of patients with oral epithelial dysplasia, excluding the lips and oropharynx. In the pathophysiology review of dysplasia since WWOM III (1998-2006), a wide range of molecular changes associated with progression of dysplasia to squamous cell carcinoma were found. These include loss of heterozygosity, dysregulation of apoptosis, aberrant DNA expression, and altered expression of numerous tissue markers. Based on the literature search, no single molecular pathway has been identified as the primary factor in progression of dysplasia to squamous cell carcinoma. A systematic review of medical (i.e., nonsurgical) management strategies for the treatment of dysplastic lesions has shown promising results in short-term resolution of dysplasia in the small number of studies that met eligibility criteria for review. However, because of the limited periods of follow-up reported in these studies, it remains unclear as whether resolution of dysplasia would actually be a long-term benefit of these interventions. This question is particularly germane when it is considered in the context of prevention of future development of squamous cell carcinoma. Because of the lack of randomized controlled trials that have shown effectiveness in the prevention of malignant transformation, no recommendations can be provided for specific surgical interventions of dysplastic oral lesions either.

a Oral Medicine Program Director, Carolinas Medical Center, Charlotte, NC.

b Professor, NOVA Southeastern University, College of Dental Medicine.

c Chairman, Department of Oral Medicine, Carolinas Medical Center.

d Head, Department of Oral Medicine, University of Glasgow, Glasgow, Scotland.

e Director of Salivary Dysfunction Clinic, Baylor College of Dentistry.

f Consultant, County Hospital, Halmstad, Sweden.

g Consultant, Department of Dermatology, Mayo Clinic, Rochester, Assistant Professor, Mayo College of Medicine, MN.

h Consultant in Oral Pathology, School of Dentistry.

i Professor, Oral Heal and Diagnostic Sciences, Division Head, University of Connecticut Health Center.

j Professor and Head of Oral Medicine, College of Dentistry, Chicago Cancer Center, Chicago, IL.

k Professor and Chairman, University of Copenhagen, School of Dentistry.

l Professor, Sahlgrenska Academy, Goteborg, Sweden.

m Senior Lecturer in Oral Medicine, Griffith University, Gold Coast, Queensland, Australia.

n Director, Research Epidemiology, Dickson Institute for Health Studies, Carolinas HealthCare System.

o Head of Department, University of Sydney, Westymend Centre for Oral Health, Westmend Hospital.

p Professor emeritus of Oral Medicine, University of California, San Francisco.

q Professor, Oral Medicine Department, Chulalongkorn University, Bangkok, Thailand.

r Chair, Oral Medicine, University of Sheffield, School of Clinical Dentistry.

s Professor of Oral Medicine and Experimental Oral Pathology, University of London, Guy’s, King’s and St Thomas’ Dental Institute, UK.

t Head, Professor of Oral Pathology, VU University Medical Centre (Vumc)/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

Reprint requests: Isaäc van der Waal, DDS, PhD, Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Centre (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057; 1007 MB Amsterdam, The Netherlands

PII: S1079-2104(06)00816-X

doi:10.1016/j.tripleo.2006.10.015

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