Basement membrane changes under neoplastic oral mucous membrane. Ultrastructural observations, review of the literature, and a unifying concept.

This study explores the morphologic nature of the basement membrane under neoplastic oral mucous membrane. Of particular interest is the progression of changes associated with dysplasia, carcinoma in situ, and invasive carcinoma. On the basis of a critical review of the literature and our own ultrastructural observations, we present a unifying concept for the development of these basement membrane changes. This concept proposes that neoplastic epithelial cells may produce a collagenolytic enzyme which is released into the epithelial intercellular spaces. This enzyme permeates to the basement membrane, causes breaks in the basement membrane, and focal loss of stromal area contiguous with intercellular spaces. The neoplastic basal cells develop pseudopodia that eventually extend through the breaks in the basement membrane. This concept suggests that the basement membrane changes herald the progression of carcinoma in situ to invasive carcinoma.