Pre-Cancerous & Cancerous Oral Lesions

 

Pre-Cancerous & Cancerous Oral Lesions

A routine part of an oral examination should be inspection not only of the teeth and gums but also of the soft tissues in and around the mouth. Dentists look for abnormal changes that are loosely called “lesions.”

 

Many lesions are innocuous and can be easily diagnosed and named based upon their appearance alone. However, some lesions are not as easy to identify and require additional diagnostic steps, such as a biopsy (removal of a piece of the lesion to examine under a microscope). A small percentage of these lesions may be premalignant or even malignant (see education sheet on Oral & Oropharyngeal Cancer).

 

What are these? Premalignant or precancerous (also referred to as “potentially malignant”) oral lesions involve the skin lining of the mouth (known as the epithelium) and may be at risk for becoming (transforming into) an oral cancer, although it is difficult to predict which lesions will transform and how long it will take (see below).
Who is at risk for these? As we grow older our risk of developing cancer increases. The same is true for premalignant lesions. Most lesions are detected in people over the age of 40 and those with similar risk factors for oral cancer, such as tobacco and/or heavy alcohol use, although such lesions can also be found in younger individuals and/or those without classic risk factors.

 

How are oral lesions detected? Premalignant lesions and early cancers are usually asymptomatic (ie the patient has no pain and they don’t even know they have a lesion), so their detection is contingent upon a careful soft tissue examination by a dentist. This examination must include the inside and outside of the lips, the cheeks (buccal mucosa), the sides and undersurface of the tongue, the floor of mouth, the gums, the roof of the mouth (palate), the back of the mouth/top of the throat (oropharynx). Most oral lesions are traumatic in nature and have no potential for cancer (Figure A). However, some oral lesions have an appearance which may raise suspicion by the dentist.

 

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