TY - JOUR
T1 - Recurrence patterns and management of oral cavity premalignant lesions
AU - Arnaoutakis, Demetri
AU - Bishop, Justin
AU - Westra, William
AU - Califano, Joseph A.
N1 - Funding Information:
This work was in part supported by a grant from the Doris Duke Charitable Foundation to Johns Hopkins Medical Institutions to fund Clinical Research Fellow Demetri Arnaoutakis.
PY - 2013/8
Y1 - 2013/8
N2 - 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 CO2/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.
AB - 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 CO2/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.
KW - Dysplasia
KW - Excision
KW - Oral cancer
KW - Premalignancy
KW - Recurrence
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U2 - 10.1016/j.oraloncology.2013.04.008
DO - 10.1016/j.oraloncology.2013.04.008
M3 - Article
C2 - 23692699
AN - SCOPUS:84880061634
SN - 1368-8375
VL - 49
SP - 814
EP - 817
JO - Oral Oncology
JF - Oral Oncology
IS - 8
ER -