Precursor lesions are designated as altered epithelium with an increased likelihood of progression to SCC. The altered epithelium shows a variety of architectural and cytological changes that have been grouped under the term dysplasia. The following architectural changes are required to diagnose epithelial dysplasia: irregular epithelial stratification, loss of polarity of basal cells, drop-shaped rete ridges, increased number of mitoses, superficial mitoses, dyskeratosis and keratin pearls within rete pegs. The cytological abnormalities of dysplasia are: anisonucleosis, nuclear pleomorphism, anisocytosis, cellular pleomorphism, increased nuclear cytoplasmic ratio, atypical mitotic figures, increased number and size of nucleoli, and hyperchromatism.
The dysplasia system includes the following categories:
A. Hyperplasia with increased number of cells. This may be in the spinous layer (acanthosis) or in the basal and parabasal cell layer (basal cell hyperplasia). The architecture of the epithelium is preserved, and there is no cellular atypia.
B. Dysplasia with three grades:
1. Mild dysplasia: architectural disturbance is limited to the lower third of the epithelium, accompanied by cytological atypia.
2. Moderate dysplasia: architectural disturbance extends into the middle third of the epithelium, accompanied by an upgraded degree of cytological atypia.
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