Premalignant and Malignant Oral Lesions

Oral cancer is the sixth most common cancer in the world, about 90% of which are squamous cell carcinomas.35 Precancerous lesions and conditions include erythroplakia, leukoplakia, candidiasis, lichen planus, actinic cheilosis, and submucous fibrosis. Most common sites of oral cancer are the tongue, floor of the mouth, lips and gingivae. Tobacco smoking and chewing betel nut are major risk factors for oral pre-malignant and malignant squamous cell lesions.36

The diagnosis is predicated on visual recognition of high-risk lesions and a confirmatory histological evaluation. However, the initial stages of pre-cancerous and cancerous lesion are almost always painless and often go undetected. Consequently, these lesions are not diagnosed until they have become symptomatic, i.e., they have reached advanced stages characterized by large ulcerations, pain, paresthesia, and lymphadenopathy.

Currently, radiotherapy and surgery are the primary treatment modalities. Surgical resection of large lesions may affect speech, swallowing, physical appearance, and the patient’s quality of life. The rate of recurrence is also high (10-30%). Consequently, improved diagnostic strategies are needed to identify patients at risk of oral cancer and for early detection of pre-malignant and malignant lesions.37

Currently available diagnostic technologies such as ViziLite®, OralCDx® Brush Biopsy, and VELscope® have their limitations. Biopsy, the gold standard for diagnosing premalignant and malignant lesions, is predicated on visual detection and is invasive.38,39 For these reasons, there is a need for specific point-of-care diagnostics for the early detection of pre-cancerous and cancerous lesions, which are non-invasive, easy to use, and are cost-effective.