Modul Oral Potentially Malignant Disorder and Malignancy

MINISTRY OF HEALTH MALAYSIA
ORAL HEALTH PROGRAMME

Simple Guide for Medical Practitioners
on

ORAL POTENTIALLY MALIGNANT
DISORDERS
AND

MALIGNANT LESIONS

1

Oral Potentially Malignant Disorders

Leukoplakia Erythroplakia Oral
Submucosa

Fibrosis

Discoid Lupus Lichen
Erythematosus Planus/Lichenoid

Reaction

2

Leukoplakia

Definition White patch or plaque which cannot otherwise
be characterized clinically or histologically as
other disease

Types Homogenous Non-homogenous

Progress to carcinoma (cancer)

3

Homogenous Leukoplakia

4

Homogenous Leukoplakia

5

Homogenous Leukoplakia

6

Homogenous Leukoplakia

7

Homogenous Leukoplakia

8

Homogenous Leukoplakia

9

Non-Homogenous Leukoplakia

• a predominantly white, or mixed red and white
(erythroleukoplakia), lesion that may be irregularly flat or
nodular/exophytic.

• Has a high potential for atypia & progress to squamous
cell carcinoma.

10

Non-Homogenous Leukoplakia

11

Non-Homogenous Leukoplakia

12

Non-Homogenous Leukoplakia

13

Non-Homogenous Leukoplakia

14

Non-Homogenous Leukoplakia

15

Non-Homogenous Leukoplakia

16

Erythroplakia

• Red velvety patch which cannot be clinically/
pathologically diagnosed as any other condition

Probability of malignant change
• Erythroplakia has the highest risk of malignancy

transformation compared to other oral mucosal
lesions at risk for transformation.
• 91% prove to be severe dysplasia or invasive
cancer

17

Erythroplakia

18

Erythroplakia

19

Erythroplakia

20

Erythroplakia

21

Oral lichen planus/lichenoid reaction
(erosive type)

22

Oral lichen planus/lichenoid reaction
(erosive type)

23

Oral lichen planus/lichenoid reaction
(erosive type)

24

Discoid lupus erythematosus

25

Discoid lupus erythematosus

26

Oral Submucosa Fibrosis

Definition Epithelial atropy and fibrosis of the subepithelial
connective tissue, resulting in stiffness of the oral mucosa.

Clinical Areas of blanching in buccal mucosa
Features
Vertical fibrous band in commissure region

Mucosa smooth, thin and atropic with underlying
fibrosis & ischaemic (caused by chewing areca nut)

The rate of malignant transformation : 3% to 19%

27

Oral Submucosa Fibrosis

28

Oral Submucosa Fibrosis

29

Suspicious clinical features

✓Red, white and speckled lesions
✓Persistent ulcer
✓Fixation to underlying tissue
✓Induration
✓Oral swelling or proliferative growth
✓Difficulty speaking or swallowing
✓Unexplained or sudden mobility of teeth

30

It may be impossible to differentiate
clinically between leukoplakia or
erythroplakia and early carcinoma

BIOPSY IS MANDATORY IN EVERY CASES IN WHICH
THE POSSIBILITY OF CANCER MAY ARISE

31

Early squamous cell carcinoma

32

Early squamous cell carcinoma

33

Early squamous cell carcinoma

34

Early squamous cell carcinoma

35

Early squamous cell carcinoma

36

Early squamous cell carcinoma

37

Early squamous cell carcinoma

38

Early squamous cell carcinoma

39

Early squamous cell carcinoma

40

Early squamous cell carcinoma

41

Squamous cell carcinoma of alveolar mucosa

42

Squamous cell carcinoma of alveolar mucosa
and sulcus

43

Squamous cell carcinoma of tongue

44

Squamous cell carcinoma of tongue

45

Squamous cell carcinoma of tongue

46

Squamous cell carcinoma of tongue

47

Squamous cell carcinoma of tongue

48

Squamous cell carcinoma of buccal mucosa

49

Squamous cell carcinoma of buccal mucosa

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