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Oral precancer and cancer
Precáncer y cáncer bucal
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It is relevant the increased prevalence in individuals aged under 40 years.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">2</span></a> The oral health professionals are responsible for the early diagnosis of lesions that can become malignant and oral cancer in its earliest stages. There are several etiologic factors involved: tobacco (smoked or chewed), drinking, diet, immunosuppression, viruses such as human papillomavirus (HPV), the presence of premalignant lesions and, in discussion for some authors, local trauma factors.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">3</span></a> Since 1978 WHO has defined injuries and premalignant oral conditions.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">4</span></a> Precancerous lesion is a morphological abnormality of tissue where oral cancer risk is higher. Precancerous condition is a systemic condition associated with increased oral cancer risk. This terminology is under review, and in 2007, Warnakulasuriya et al.<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">5</span></a> introduced the name of potentially malignant lesions, which despite not having complete consensus, is prevailing over the former classification. These authors define them as potentially malignant lesions (lesions at risk of developing malignant tumors at higher rates than normal adjacent tissue).<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In this paper we review the literature on these entities and their diagnosis, in order to highlight the role of healthcare in their recognition and early diagnosis. To this purpose we have looked up the following keywords in PubMed: <span class="elsevierStyleItalic">premalignant oral lesions prevention</span>. Clinical trials have also been searched from January 2011 to date with the following keywords: <span class="elsevierStyleItalic">oral cancer prevention AND dentistry.</span></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Of the 373 papers found, 139 in the last 10 years, 61 have been discarded when reading the title, 2 because they are related to HIV-AIDS and one for being a paper on angiogenesis inhibitory activity of thalidomide in an animal model in 70 hamsters. Nine of the remaining papers are on other entities, 17 are personal opinions or related to specific features of oral cancer, 39 of them are reviews (8 systematic reviews), one is a meta-analysis, and the other a controlled clinical trial in humans. Other 2 clinical trials of previous years were reviewed, both of 1998 and belonging to the group of the University of Helsinki.<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">6,7</span></a> One of the 12 recent controlled clinical trials found is consistent with the previous search.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">6</span></a> Six of the remaining 11, after having read the full text are on the cancer treatment previously provided.<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">6–11</span></a> One paper stresses the importance of lugol's iodine staining in evaluating stages I and II of tongue cancer. Atalay et al. analyzed the potential usefulness of bisphosphonates,<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">13</span></a> Pai and Prasad studied the effects of smoking on the levels of carbon monoxide,<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">14</span></a> Lopes et al. studied whether or not antibiotic prophylaxis is convenient,<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">15</span></a> and only one is a clinical trial.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">16</span></a> It is a work in Saudi Arabia that analyzes the knowledge that students, dental assistants, general practitioners and specialists have on precancer. The authors<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">16</span></a> concluded that from 41.2 to 63.4% are competent to conduct a proper examination of the oral cavity and palpate the lymph nodes. Competence increases with the higher level of education, experience and access to continuing education studies. 82% are in favor of suspicious lesions. Uti and Fashina,<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">17</span></a> in the first search, stress on this very same issue. In this paper the authors discuss about the poor knowledge on precancerous lesions by the odontology students of the School of Medicine, University of Lagos, Nigeria. We should also highlight a paper on chemotherapy,<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">18</span></a> one on Intensity Modulated Radiation Therapy,<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">19</span></a> one on cryotherapy<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">20</span></a> and another one on dental restoration techniques.<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">21</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We consider three aspects to analyze the most relevant data: oral precancer, oral cancer and methods for early diagnosis of oral cancer.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Precancer</span><p id="par0025" class="elsevierStylePara elsevierViewall">In addition to the exogenous factors that can stimulate dysplastic transformation, there is a number of endogenous factors involved: the various potentially malignant lesions (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Among them we will review leukoplakia, erythroplasia and lichen planus (LP).<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Leukoplakia</span><p id="par0030" class="elsevierStylePara elsevierViewall">Leukoplakia is the most frequent precancerous lesion of the oral mucosa; it is defined as a predominantly white lesion, which cannot be detached by scraping and clinically and histologically does not belong to any other entity.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">4</span></a> Since the criteria provided in 2002,<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">22</span></a> a provisional diagnosis is suggested, then the potential etiologic factors are removed for 2–4 weeks (not enough time if the etiology is smoking) and, if it does not disappear, confirm histologically. Today, a lower incidence than a few years ago is accepted. Thus, the paper by Scheifele et al.<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">23</span></a> in 16,128 individuals, reports a prevalence of 0.66% in men and 0.21% for women. The most frequent sites were the buccal mucosa and tongue. The study conducted in 1586 Brazilian subjects by Carrard et al.<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">24</span></a> also reports low percentages for leukoplakia (1.01%) and LP (1.02%), highlighting the potential relationship with some viruses. We should recall that from a clinical point of view the classification used is the provided by the Conference of Uppsala 1994<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">25</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). If we focus on the possible malignancy, Pindborg in 1968,<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">26</span></a> reports figures ranging from 0.1 to 17%. However, Scheifele et al., in 2003,<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">23</span></a> suggested that the annual malignant transformation was under 1%, being of most risk the lesions on the floor of the mouth, the nonhomogeneous lesions, dysplasias and those with certain molecular markers (particularly the p53, Loss of heterozygosity, DNA content and classification of nucleolar organizer regions related to Ag “AgNOR”). As for the treatment, to remove, if any, the etiological factors, and perform tumor excision is recommended, if possible. Drug therapies have been tested with vitamin A, calcipotriol, retinoic acid, beta carotene, bleomycin, curcumin, etc., with inconclusive results.<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">26,27</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Erythroplasia</span><p id="par0035" class="elsevierStylePara elsevierViewall">Erythroplasia and its most common mixed form, the erythroleukoplakia, fall within the concept of red lesions of the oral cavity, and as such deserve special diagnosis, because sometimes we are facing a carcinoma in situ. These lesions should always be biopsied, and some authors recommend the biopsy to be performed in the department of head and neck surgical oncology surgery, since the result is usually malignancy. In its pathogenesis etiologic agents in common with leukoplakia are suggested.<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">28</span></a> Clinically it is generally an asymptomatic red spot, which cannot be diagnosed as any other definable injury.<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">25</span></a> Usually located in the soft palate, floor of the mouth and buccal mucosa. The male/female ratio is 1:1 and it is more frequent in Asian patients.<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">28</span></a> Malignancy rate is higher compared to leukoplakia.<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">29</span></a> Reichart and Philipsen,<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">28</span></a> for example, reported that in the homogeneous forms, 51% are invasive carcinomas, 41% carcinoma in situ, and the remaining 9% are mild or moderate dysplasia. The factor enhancing the evolution to malignancy is unknown, but chronic infection by Candida albicans or by HPV have been considered, among others.<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">28,30</span></a> Their treatment is surgical excision and full histopathology study, but there are some promising papers with photodynamic therapy, both for this entity and proliferative verrucous leukoplakia.<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">31</span></a> If lesions are very large, some complementary diagnostic technique might be convenient, and it is essential to convince the patient to abandon the related toxic habits.<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">32</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Lichen planus</span><p id="par0040" class="elsevierStylePara elsevierViewall">It is a chronic inflammatory mucocutaneous disease, with various clinical manifestations of unknown etiology and frequent oral manifestations.<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">33</span></a> Some researchers show a prevalence of 0.1–4%, and most patients are women over 50 and postmenopausal. The simplest classification consists of three clinical forms called oral lichen planus (OLP), reticular (white), atrophic-erosive OLP (red), and the combination of both. Reticular LP is the most frequent form.<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">34</span></a> Atrophic-erosive OLP appears mainly on the tongue, buccal mucosa and gums. Reticular forms are usually symmetrical, asymptomatic and appear on the buccal mucosa. And although the etiology is unknown, today it is accepted that genetic factors (HLA family relations), hormonal (differences between men and women) and environmental (viruses, drugs, stress and other disorders) triggers an immune disorder that affects basal cells of the epithelium, being the dermal infiltrate a secondary manifestation. Its etiologic relationship with different viruses or Helicobacter pylori is inconclusive.<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">35</span></a> Among the trigger factors, psychological factor has an important role, and its association with systemic diseases such as hepatitis C, diabetes or hypertension has been discussed.<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">36</span></a> Periodic monitoring is important because it is potentially malignant.<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">34,37</span></a> It is also important to remember that there is a number of injuries difficult to distinguish from the clinical manifestations of OLP: they are called lichenoid reactions. There exist oral lichenoid contact reactions (allergic contact reactions due to delayed hypersensitivity, and the material frequently involved is amalgam), lichenoid drug reactions and lichenoid reactions in graft-versus-host disease.<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">38</span></a> LP skin lesions may appear as 2–4<span class="elsevierStyleHsp" style=""></span>mm diameter papules, polygonal shape, and appear in isolation, or grouped to form distinct plates. Usually pink, then they are turning to a purplish or brownish red. Like oral lesions, on its surface white striations (Wickham striae) are located, and when disappearing, melanin pigmentation might remain. 80% cases are itchy and their most frequent site is the flexor surfaces, particularly in the anterior surface of the wrist; the capillaries may be presented as alopecia plates.<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">33,34</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Symptomatology is essential for the diagnosis, but biopsy should be performed to confirm it and allow rule out potential dysplasia or malignancy.<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">38</span></a> Direct immunofluorescence can be positive in the basement membrane (nonspecifically) to fibrinogen and also to IgM to a lesser extent. White forms can disappear spontaneously, but red forms rarely do. Oral forms are considered more chronic than the ones on the skin, and more difficult to treat. As a general rule we can say that the white forms do not require treatment and that the atrophic-erosive forms, which usually produce symptoms are treated with topical corticosteroids and, sometimes, systemic corticosteroids or other alternatives.<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">39,40</span></a> The criteria for its possible evolution to malignancy were already provided in 1999<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">41</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Oral cancer</span><p id="par0050" class="elsevierStylePara elsevierViewall">The etiologic factors of oral cancer do not differ from those of premalignant lesions, and some recent studies discuss the possible value of the chronic irritation of the prosthesis, at least in tongue cancer.<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">42</span></a> In 95% cases, oral cancer is squamous cell carcinoma, and the most common clinical presentation is a ulcerovegetative infiltrative lesion, round and raised edges, irregular contour, surface roughness, based indurated on palpation and prone to spontaneous bleeding or rubbing. In early stages, it usually occurs as a small ulcer, sometimes accompanied by white areas, but we should not forget that it can also occur as verrucoide or proliferative. Squamous cell carcinoma is prone to regional progression (usually neck) through the lymphatic stream, but occasionally can be spread at a distance, being the lung and liver the organs most frequently involved. Its prognosis is 50% at 5 years,<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">3</span></a> and is determined by the condition of the patient, the type and degree of histological differentiation, and most particularly by the clinical stage at diagnosis (TNM). Regarding treatment, there is extensive medical literature stating that it should be multidisciplinary, engaging different specialists (oncologists, oral and maxillofacial surgeons, radiotherapists, chemotherapists, dentists, psychologists and nutritionists).<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">11–15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">At the end of this section we will discuss what should be the attitude of health professionals, particularly dentists and primary care physicians, toward this disease (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">38,39,42</span></a> The priority is the systematic oral examination based on the knowledge of all potentially malignant tumors, allowing early diagnosis which, along with having a healthy mouth before treatment,<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">42,43</span></a> will determine a better prognosis (up to 80% survival at 5 years)<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">42</span></a> and lower post-treatment complications.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Early diagnosis of precancerous lesions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Definitive diagnosis of any suspicious lesions in the oral cavity should be determined by biopsy. The degree of dysplasia is considered a good predictor of progression.<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">44</span></a> Currently, there is a number of techniques to optimize the diagnosis and, in some cases, in very large and susceptible populations screening techniques can be used. The most important aspects are described as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Vital dyes</span>. The use of pigment fixing the cell nuclei with high reproductive rate allows to locate the best areas for biopsy, thereby improving their sensitivity and specificity. Toluidine blue, methylene blue, rose bengal and lugol's iodine are used. Recent research<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">45</span></a> shows a sensitivity rate close to 95% and specificity from 65 to 90%. A few studies suggest acetic acid 10% cause chelation of epithelial cell surface proteins, and optimizes the level of visual diagnosis.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Optical techniques</span>. Various techniques based on selective illumination of cervical mucus used in gynecology (colposcopy), have been developed for oral examination in order to make an early diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">46–48</span></a> Autofluorescence techniques are used (VELscope<span class="elsevierStyleSup">®</span>). This is a method associated with changes in the structure and metabolism of the epithelium and in the subepithelial stroma, results observed from its interaction with light of a certain wave length.<a class="elsevierStyleCrossRefs" href="#bib0530"><span class="elsevierStyleSup">47,48</span></a> López-Jornet and de la Mano-Espinosa<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">49</span></a> confer sensitivity and specificity above 98 and 94%, respectively. Another technique is auto chemiluminiscence (ViziLite Plus<span class="elsevierStyleSup">®</span>),<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">50</span></a> in which acetic acid is used as a chelating agent of the surface proteins, and the emission of polarized light responds with a reduced fluorescence in the affected area. These two techniques have the disadvantage of creating false expectations in professionals.<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">47</span></a> Orascoptic<span class="elsevierStyleSup">®</span><a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">51</span></a> and MicroLux<span class="elsevierStyleSup">®</span><a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">52</span></a> are also used. The sensitivity and specificity of these techniques are highly variable, depending on the studies and experience of the professionals using them. Under no circumstances they can be used as the only technique for early diagnosis. One of the uses under study, for these procedures, is the analysis of the surgical margins. Analysis of different combined methods are referenced in the papers by Patton et al.,<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">51</span></a> Sambandham et al.<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">53</span></a> and Huber.<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">54</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cytological techniques</span>. They are based on the effectiveness demonstrated by the triple smear Papanicolaou technique in the gynecologic cytology. Orally, it is unsystematic, and as a screening technique it should allow collect a minimum of 5 samples in each procedure, and in the case of oral cytology, each sample requires a new kit. This makes it impractical and expensive. It may be of some use in monitoring lesions diagnosed or areas treated due to a previous injury. They can also be associated with techniques searching for genetic, molecular, or chromosomal abnormalities. OralCDx<span class="elsevierStyleSup">®</span><a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">55</span></a> is the technique most widely used. Trullenque-Eriksson et al.<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">46</span></a> analyzed the sensitivity and specificity of this and other methods previously mentioned, with a 71–100% sensitivity and a 32–100% specificity. More recently, Reboiras-López et al.<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">56</span></a> give it a new value when attached to the novel techniques for detecting RNA. In accordance with these authors, current research search for specific tissue (biopsy) or cell (cytology) molecular markers. However, a radical change in the prognosis of this entity would be obtaining markers of patient's saliva, which is being increasingly studied.<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">57</span></a> Thus, recent studies such as Janczyk et al.<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">58</span></a> claim that in the analysis of saliva it has been found annexin A8 and peroxideroxin-2 protein overexpression, which have been previously described in samples of oral cancer. Therefore, saliva might be used as a method to detect early oral cancer; while the results are encouraging, they are far from the required effectiveness.<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">59</span></a></p></li></ul></p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusions</span><p id="par0080" class="elsevierStylePara elsevierViewall">We can finally say that the best diagnostic method begins with a careful and systematic review of the oral cavity and if an injury is suspected, a biopsy is required. Histopathology allows assessing the injury, the degree of abnormality and its potential tendency to malignancy. On the other hand, although there are marketed a series of coadjuvant treatments, to optimize the diagnosis, particularly in susceptible populations, we should only consider them as coadjuvant screening therapy.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflict of interests</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors report no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres633047" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec645694" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres633048" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec645695" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Discussion" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Precancer" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Leukoplakia" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Erythroplasia" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Lichen planus" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Oral cancer" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Early diagnosis of precancerous lesions" ] ] ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusions" ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-10-08" "fechaAceptado" => "2014-11-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec645694" "palabras" => array:7 [ 0 => "Cancer" 1 => "Precancer" 2 => "Pre-malignant lesions" 3 => "Malignant lesions" 4 => "Potentially malignant disorders" 5 => "Oral lichen planus" 6 => "Leukoplakia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec645695" "palabras" => array:7 [ 0 => "Cáncer" 1 => "Precáncer" 2 => "Lesiones premalignas" 3 => "Lesiones malignas" 4 => "Lesiones potencialmente malignas" 5 => "Liquen plano oral" 6 => "Leucoplasia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We reviewed the concept of oral precancerous lesions, oral cancer, and the possibility of early diagnosis. With the keywords: <span class="elsevierStyleItalic">premalignant oral lesions prevention</span>, a search was performed over the past 10 years. Also clinical trials are searched from January 2011 until today with the keywords: <span class="elsevierStyleItalic">oral cancer prevention AND dentistry</span>. It is emphasized that there can be no significant changes related to the concept of precancerous lesions and cancer, and those relating to the early diagnosis. Despite the numerous described methods of screening, biopsy remains the most useful test, and therefore it is essential, mainly if we consider the new possibilities of molecular studies.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se revisa el concepto de lesiones precancerosas orales, de cáncer oral y su diagnóstico precoz. Con las palabras clave: <span class="elsevierStyleItalic">premalignant oral lesions prevention</span> se realiza una búsqueda de los 10 últimos años. También se buscan los ensayos clínicos desde enero de 2011 hasta la actualidad con las palabras clave: <span class="elsevierStyleItalic">oral cancer prevention AND dentistry</span>. Se destaca que no hay cambios significativos relacionados con el concepto de lesión precancerosa y cáncer, y que en cuanto al diagnóstico precoz, si bien se describen numerosos métodos de cribado, la biopsia sigue siendo la prueba más útil y, por tanto, imprescindible, más aún si consideramos las nuevas posibilidades de estudios moleculares.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López-López J, Omaña-Cepeda C, Jané-Salas E. Precáncer y cáncer bucal. Med Clin (Barc). 2015;145:404–408.</p>" ] ] "multimedia" => array:4 [ 0 => array:9 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source</span>: Warnakulasuriya et al.<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">5</span></a>" "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leukoplakia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Erythroplasia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Palatal lesions in reverse smokers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oral submucous fibrosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Actinic keratosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lichen planus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Discoid lupus erythematosus \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1038331.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Potentially malignant lesions in the oral cavity.</p>" ] ] 1 => array:9 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source</span>: Axéll et al.<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">25</span></a>" "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Classification: appearance</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Homogeneous</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Injury predominantly white, uniform, firm, thin, smooth or wrinkled surface, which sometimes has shallow grooves \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nonhomogeneous</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Injury, predominantly white, which can alternate with other red areas and/or irregular, nodular or exophytic surface \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Erythroleukoplakia: mixed white and red areas \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Nodular leukoplakia: red and/or white rounded excrescences \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Exophytic leukoplakia: formerly called warty. Grows in volume outwardly with rounded or pointed projections \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Classification: etiology</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">True leukoplakia</span>. No associated factors other than smoking \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Idiopatic leukoplakia</span>. No associated factors \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Secondary leukoplakia</span>. A causal factor is detected \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1038329.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Clinical classification of leukoplakia based on the criteria provided by the Conference of Uppsala.</p>" ] ] 2 => array:9 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from Van der Meij et al.<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">41</span></a>" "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="5" align="left" valign="top">A</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">A clinical diagnosis of OLP and histopathology in which there are at least two of the following criteria is required</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hyperkeratosis or parakeratosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Intraepithelial serrated peaks \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hydropic degeneration of the basal layer \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infiltrated in subepithelial band \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">B</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">History and follow-up</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>The clinical and pathological data indicating the transformation should be properly documented (both in previous injuries and after degeneration) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Registration of clinical patient data should be available (age, sex, location of lesions) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Should be followed for at least 2 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Patient should not smoke (in those patients with carcinoma and smoking, tobacco should be considered as potentially responsible for the malignant transformation) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1038330.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Criteria for malignancy of oral lichen planus.</p>" ] ] 3 => array:9 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from Al-Hashimi et al.,<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">38</span></a> Bagan et al.<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">39</span></a> and Albuquerque et al.<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">42</span></a>" "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">You should contact:</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>The prevention of disease (recognizing and managing precancerous lesions, eliminate chronic local irritants, etc.) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Early diagnosis (by oral examination in regular dental visits) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Proper patient information (in matters of prevention of disease and the disease itself) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; 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