OBJECTIVE: To gain an understanding of head and neck mucosal premalignant recurrence and progression based on histology, treatment modality, and risk factors. DESIGN: Retrospective chart review. SETTING: Academic medical center. PATIENTS: Patients who were followed or treated for oral cavity dysplasia/carcinoma in situ. MAIN OUTCOMES MEASURES: Comparisons with clinical features, degree of dysplasia, anatomical location, rate of recurrences as well as malignant transformation and overall outcome were made. RESULTS: Of the 136 patients who were included in the study, 20% (n = 27) initially presented with mild dysplasia, 39% (n = 53) with moderate dysplasia, 21% (n = 29) with severe dysplasia, and 20% (n = 27) with carcinoma in situ. Wide local excision (HR 0.54, p = 0.05) was associated with reduced local recurrence in comparison to observation. In comparison to observation, both wide local excision (HR 0.43, p = 0.04) and CO(2)/NO Yag laser treatment (HR 0.14, p = 0.02) of dysplastic lesions significantly reduced progression to cancer. Management of mild dysplasia included observation (n = 13), excision (n = 10) and laser therapy (n = 3). Six of the 13 observed patients suffered a premalignancy recurrence, whereas only 4 of the 13 patients who underwent excision/laser treatment experienced a recurrence. Similarly, 5/13 observed patients eventually progressed to malignancy in comparison to only 2/13 patients who underwent initial excision/laser treatment. CONCLUSION: Wide excision and/or ablation of head and neck mucosal premalignancy is more effective than observation in preventing recurrence of premalignancy and progression to malignancy. Mild dysplasia has a potentially high rate of recurrence and progression to malignancy when observed, and may be treated by wide excision or ablation.
OBJECTIVE: To gain an understanding of head and neck mucosal premalignant recurrence and progression based on histology, treatment modality, and risk factors. DESIGN: Retrospective chart review. SETTING: Academic medical center. PATIENTS: Patients who were followed or treated for oral cavity dysplasia/carcinoma in situ. MAIN OUTCOMES MEASURES: Comparisons with clinical features, degree of dysplasia, anatomical location, rate of recurrences as well as malignant transformation and overall outcome were made. RESULTS: Of the 136 patients who were included in the study, 20% (n = 27) initially presented with mild dysplasia, 39% (n = 53) with moderate dysplasia, 21% (n = 29) with severe dysplasia, and 20% (n = 27) with carcinoma in situ. Wide local excision (HR 0.54, p = 0.05) was associated with reduced local recurrence in comparison to observation. In comparison to observation, both wide local excision (HR 0.43, p = 0.04) and CO(2)/NO Yag laser treatment (HR 0.14, p = 0.02) of dysplastic lesions significantly reduced progression to cancer. Management of mild dysplasia included observation (n = 13), excision (n = 10) and laser therapy (n = 3). Six of the 13 observed patients suffered a premalignancy recurrence, whereas only 4 of the 13 patients who underwent excision/laser treatment experienced a recurrence. Similarly, 5/13 observed patients eventually progressed to malignancy in comparison to only 2/13 patients who underwent initial excision/laser treatment. CONCLUSION: Wide excision and/or ablation of head and neck mucosal premalignancy is more effective than observation in preventing recurrence of premalignancy and progression to malignancy. Mild dysplasia has a potentially high rate of recurrence and progression to malignancy when observed, and may be treated by wide excision or ablation.
Authors: Susan R Mallery; Meng Tong; Brian S Shumway; Alice E Curran; Peter E Larsen; Gregory M Ness; Kelly S Kennedy; George H Blakey; George M Kushner; Aaron M Vickers; Brian Han; Ping Pei; Gary D Stoner Journal: Clin Cancer Res Date: 2014-01-31 Impact factor: 12.531
Authors: Veronika Shavlokhova; Christa Flechtenmacher; Sameena Sandhu; Michael Vollmer; Andreas Vollmer; Maximilian Pilz; Jürgen Hoffmann; Oliver Ristow; Michael Engel; Christian Freudlsperger Journal: Diagnostics (Basel) Date: 2021-05-26