Other precancerous conditions

Precancerous conditions (PCs) are generalized clinical states associated with a significantly increased risk for SCC. Epithelial atrophy, increased mitotic activity and impaired epithelial repair mechanisms are fundamental to PCs of different etiology.

Iron deficiency

Originally described in the context of sideropenic dysphagia, it is an important cause of epithelial atrophy. The association of iron deficiency with oropharyngeal squamous cell carcinomas has been observed since the mid-thirties of the 20th century {21}. However, a significant decrease of cases with hypopharyngeal cancers and iron deficiency was noted in Sweden in the seventies {1433}. Few cases of oral cancer and iron deficiency have been published in the last 20 years.

Leukoplakia

Fig. 4.16 Proliferative verrucous leukoplakia (PVL) A Extensive, thick, white plaques. B Hyperplasia and dense hyperkeratosis of early PVL. C Histology from a clinical case of PVL showing verrucous surface with hyperkeratosis, hypergranulosis and a dense inflammatory infiltrate in the corium. D Same case as shown on fig. C two years later showing more florid verrucous hyperplasia illustrating the progressive nature of the condition.

Fig. 4.16 Proliferative verrucous leukoplakia (PVL) A Extensive, thick, white plaques. B Hyperplasia and dense hyperkeratosis of early PVL. C Histology from a clinical case of PVL showing verrucous surface with hyperkeratosis, hypergranulosis and a dense inflammatory infiltrate in the corium. D Same case as shown on fig. C two years later showing more florid verrucous hyperplasia illustrating the progressive nature of the condition.

Stage Squamous Cell Cancer
Fig. 4.17 Sideropenic dysphagia. Iron deficiency anaemia with depapillated tongue, depigmentation of the upper lip and epithelial erosion of the lower lip.
Pvl Histology
Fig. 4.18 Erythroplasia / erythroplakia associated with oral lichen planus (precancer).
Stage Squamous Cell Carcinoma
Fig. 4.19 Syphilis. Interstitial glossitis due to late stage syphilis with squamous cell carcinoma at the left tip of the tongue (Collection of J.J. Pindborg, M.D., Copenhagen).

Oral lichen planus

OLP is a chronic mucocutaneous immune inflammatory condition. Malignant transformation is still controversial {639,2359}; one review reporting malignant transformation rates between 0% and 5.6% {2116}.

The controversy is due to lack of uniform clinical and histological criteria for OLP and oral lichenoid lesions (OLL). The latter have also been termed interface mucositis or lichenoid mucositis. Oral lichenoid lesions have been considered by some to represent the lesion at risk if associated with dysplasia. In a recent study {2664} it was shown that all cases of malignant transformation (1.7%) involved cases of OLL and not OLP. Similarly, a study {2896} investigating whether OLP without dysplasia is premalignant by using microsatellite analysis for loss of heterozygosity (chromosomes 3p, 9p, 17p) did not support OLP as a lesion at risk.

However, until distinct clinical and histo-logical criteria have been developed on how to differentiate OLP from OLL, both lesions have to be considered as 'at risk for malignant transformation'.

Oral submucous fibrosis (OSF)

This chronic, progressive condition of the oral mucosa {2115} is etiologically strongly associated with the chewing of areca nut which has recently been categorized by IARC as a human carcinogen {1}. It is almost exclusively seen in ethnic groups using areca nut alone or as a component of betel quid.

Clinically there is mucosal rigidity of varying intensity due to fibroelastic transformation of the juxtaepithelial connective tissue. Fibrous bands and mucosal pallor are characteristic {498}. Histologically, there is epithelial atrophy, keratosis and dysplasia in up to 25% of cases {498}. In a population-based prospective study, in India, SCC developed in 7% of patients with OSF over a period of 17 years {1798}.

Syphilis

Late stage (tertiary) syphilis associated with leukoplakia had a high risk of malignancy, but this is now largely of historical interest {1721}.

Xeroderma pigmentosum

This is a rare neurocutaneous disease with an autosomal-recessive mode of inheritance. The syndrome is caused by deficient nucleotide excision repair mechanisms {2090}. The skin, including the lips, is affected and shows epithelial atrophy and hyperpigmentation. Patients are extremely sensitive to light and show an increased predisposition to UV-asso-ciated malignancies of the skin. Carcinomas of the tongue have also

Subepithelial Fibrosis
Fig. 4.20 Oral submucous fibrosis with a broad band of subepithelial collagenous tissue.

been described {1306,1994,2704}.

Lupus erythematosus

This is a chronic autoimmune disease of unknown etiology. Carcinomas, mainly of the lips, have been described in affected individuals {2264,2696}.

Epidermolysis bullosa dystrophicans (Hallopeau-Siemens type)

This disease of the skin and oral mucosa has an autosomal dominant pattern of inheritance. Oral leukoplakia and occasional cases of SCC have been observed in association with epidermolysis bullosa {226,2288}.

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  • Zula
    Can iron deficiency cause gingival gum squamous cell carcinoma?
    7 months ago

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