1. Dysplasia
   1. Mild
   2. Moderate
   3. Sever
   4. Carcinoma in situ
2. Developmental / Hereditary
   1. Leukoedema
   2. White sponge nevus
3. Reactive /Hyperplastic
   1. Frictional keratosis
   2. Nicotine Stomatitis
   3. Squamous papilloma
   4. Verruca vulgaris
   5. Focal epithelial hyperplasia
   6. Verruciform xanthoma
4. Immunologic
5. Precancerous & Cancerous
   1. Leukoplakia
      1. Intro.
         1. A
            1. WHO definition
         2. Premalignant
      2. Incidence & prevalence
         1. 5-25% of leukoplakia
         2. Most common oral precancerous lesion (85%)
         3. M>F
      3. Etiology
         1. Tobacco
            1. 80% of pt with leukoplakia are smokers
            2. Heavier > lighter (NO. + size )
            3. smokeless tobacco
            4. tobacco pouch keratosis
         2. Alcohol
            1. No association
            2. Grey buccal mucosa
         3. Sanguinaria
            1. With tooth paste or mouth rinse w/ herbal extract
            2. Sanguinaria associated keratosis
            3. In maxillary vestibule or max. alveolar mucosa
            4. A
            5. A
            6. Uncertain regarding ( malignancy)
            7. After stopping habit >> can persist
         4. Ultraviolet radiation
            1. Lower lip
         5. Microorganisms
            1. Treponema palladium
            2. Stiff tongue + dorsal leukoplakia
            3. Candida albicans
            4. Candida hyperplasia or candidal leukoplakia
            5. Which one come before the other ?
            6. HPV (16-18)
         6. Trauma
            1. Nicotine stomatitis
            2. Frictional keratosis
            3. Should be differentiated from leukoplakia
      4. Clinical +Hiso features
         1. M>F
         2. Mean=60 y
         3. 70%
            1. lip,gingiva , buccal mucosa
         4. 90%
            1. lip,tongue, floor of the mouth
         6. Proliferative verrucous leukoplakia
      5. Tx and prognosis
         1. Definitive DX
            1. Biopsy
            2. Most sever area
            3. Multiple ( depends)
         2. Complete removal
            1. If no dysplasia
            2. Observation
            3. stop smoking
            4. Vit A
         3. Follow up
            1. Granular recurrence
   2. Erythroplakia
      1. Intro.
         1. B
         2. Which is more common ?
      2. Clinical
         1. Older men
         2. Floor of the mouth , soft palate and tongue
      3. Histo
         1. Lack of keratinisation
         2. atrophic epithelium
         3. Malignant change
         4. Sever dysplasia
         5. Carcinoma in situ
         6. Superficially invasive SCC
      4. Tx and prognosis
         1. Definitive DX
            1. Biopsy
            2. Most sever area
            3. Multiple ( depends)
         2. Complete removal
         3. Follow up
   3. Smokeless tobacco associated lesions
      1. Intro.
         1. Spit tobacco use
      2. Clinical
         1. caries
         2. staining
         3. occlusal and incisal wear
         4. Halitosis
         5. Snuff pouch or tobacco pouch
      3. Histo.
         1. Non specific
         2. Chevron
         3. Increase subepithelial vascularity
         4. vessel engorgement
         5. Dysplasia
            1. Uncommon but it can happen
      4. Tx and prognosis
         1. DX
            1. History
            2. Clinical exam
         2. Biopsy
         3. Habit cessation
         4. Malignant transformation
            1. Low
   4. Squamous cell carcinoma
      1. Intro
         1. Epidemiology
            1. In saudi arabia
            2. 149 cases/year
         2. Etiology
            1. Extrinsic
            2. Tobacco smoke
            3. smokeless tobacco
            4. Betel quid
            5. alcohol
            6. Phenols
            7. Radiation
            8. Sunlight
            9. X-RAY
            10. Syphilis
            11. Candida infection
            12. Oncogenic viruses
            13. HPV
            14. Intrinsic
            15. General malnutrition
            16. Iron deficiency anemia
            17. Plummer- vinson syndrome
            18. Vit A deficiency
            19. Immunosuppression
            20. AIDS
            21. TX
            22. Organ transplantation TX
            23. Malignancy TX
            24. Oncogene or tumor suppressor gene
      2. Clinical
         1. Appearance
         2. Vermilion carcinoma
         3. Inraoral cancer
            1. Most common site
            2. Tongue (posterior lateral and ventral )
            3. Other sites
            4. Floor of the mouth
            5. Soft palate
            6. Gingiva
            7. Buccal mucosa
            8. Labial mucosa
            9. hard palate
            10. Staging
            11. T
            12. N
            13. M
            14. STAGES
      3. Histo.
         1. Invasion
            1. Superficially invasive
            2. Deeply invasive
         2. Grading
            1. Well differentiated OSCC (grade1)
            2. Moderately differentiated OSCC (grade 2 )
            3. Poorly differentiated OSCC (grade 3 or 4)
      4. TX and prognosis
         1. Intraoral cancer
            1. Surgical resection (wide)
            2. w/ or w/o neck radical dissection
            3. Radiation therapy
            4. Combination
         2. Prognosis
            1. depends on the staging
   5. Verrucous carcinoma
      1. Intro
         1. 1-10 % of OSCC
         2. In spit tobacco users, a regular squamous cell carcinoma is 25 times more likely to develop than this low-grade variant.
      2. Clinical
         1. Site
            1. Mandibular vestibule
            2. Buccal mucosa
            3. Hard palate
            4. Often corresponds to the to the site of chronic tobacco placement
         2. Late diagnosis ?!!
      3. Histo.
         1. deceptively benign microscopic appearance
         2. wide and elongated rete ridges that appear to push” into the under lying connective tissue
         3. abundant keratin (usually parakeratin) production
         4. a papillary or verruciform surface
         5. no significant degree of cellular atypia
         6. No direct invasion !!!
         7. an intense infiltrate of chronic inflammatory cells in the subjacent connective tissue.
         8. an adequate incisional biopsy.
      4. TX and prognosis
         1. Surgical resection
         2. Radiation ?!
         3. Chemotherapy