Evaluation

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Evaluation Treatment of the Dental patient for
Cancerous Precancerous Lesions Mac
Whitesides DMD, MMSc. Atlanta, GA
Doctormac_at_mindspring.com
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Oral SCCA USA 3 of all cancers 43,000
new cases 8,260 deaths 6th most common
malignancy Georgia 680 new cases 190
deaths usually detected early usually
detected by dental professionals
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Oral Precancerous Lesions 1. Leukoplakia white
plaque that can not be described otherwise
ETI tob, trauma, tertiary syphlitic glossitis
CLINCAL most common oral precancer (85) 5th
to 6th decade MgtgtF lip vermillion gt BM gtMn.
Gingvia gt tongue gt oral floor gt HP gt SP
more common more likely to undergo
malignant transformation in males gt 40 yrs
Early, Moderate, Severe
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Oral Precancerous Lesions Leukoplakia TX
remove any etiologic agent observe for two
weeks biopsy if suspicious PROGSCCA much
more common in pts with Leukoplakia vs.
without 90-95 benign if have dysplasia or
CA in situ also, then more likely to become
malignant
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Oral Precancerous Lesions 2. Erythroplakia red
plaque that can not be described
otherwise FOM gt SP gt RTMP gt tongue
less common than Leukoplakia, but more likely
to be malignant
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Oral SCCA Presentationirregular, indurated,
painful, painless,
erythroplakia-likeleukoplakia-like,
ulcerative, exophytic, or benign Age 5th to
9th decade Grades CA in situ, mild, moderate,
severe dysplasia Location Tongue gt FOM gt Buccal
Mucosa gt Alveolar Mucosa gt Palate

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Oral SCCA

Risk Factors TOB ETOH age family Hx
previous Hx of oral SCCA
race syphilis poor oral hygiene Betel Nut

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It is evident therefore that no man
should venture upon snuff who is not sure that he
is not so far liable to a cancer and no man can
be sure of that. John Hill 1761
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40 yo w male SCCA
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40 yo w male SCCA 1 wk post Bx
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68 yo male SCCA
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Verrucous Carcinoma an exophytic,
well-differentiated form of SCCA ETITOB,
Trauma, Viral CLINICAL7 of all SCCA 7th to
8th decades, Mgt F BMgt Gingivagt other sites TX
Surgical removal PROGNOSIS 75 five year
survival rate
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Oral Lesions 1. Detection 2. Inspection
3. Evaluation 4. Suspicion
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Treatment
1. Radiation 2. Chemotherapy 3. Surgery 4.
Combination
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Staging T Primary Tumor Size N Node
Involvement M Metastasis Prognosis State at
Diagnosis Location of Primary Tumor Metastasis
SCCA
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Radiation
effective in treating T1 or T2
lesions delivered in divided doses to maximize
effect on tumor minimize effect on normal
tissue delivered in 1.8 to 2.0 Gy per day, max
at 5000 to 6000 Gy Hyperfractionation deliver
lt 2.0 Gy BID advantage net 10 to 15
increase in dose, with less effect on normal
tissue Acceleration 2.0 Gy BID advantage
counteracts tumor cell re-population Side
Effects Xerostomia, Tissue Fibrosis,
Caries, Osteomyelitis
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Chemotherapy
Treats macroscopic, microscopic, and metastatic
disease Used with XRT, Surgery Therapy
Combination, Neoadjuvant, Adjuvant,
Palliative Agents Cisplatin, Carboplatin,
Fluoroucil, Methotrexate Side Effects
Xerostomia, Caries, Infections, Alopecia, Bone
marrow toxicity, Nausea, Vomiting, Mucosal
toxicity
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Surgery Primary Site 1 cm margin of non diseased
tissue Defect local, rotational, free flaps,
distraction osteogenesis Post op Chemo/XRT
??? Regional SCCA has invaded neck Primary
resection neck dissection (radical vs
modified radical) Post op Chemo/ XRT ???
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Antioxidants Naturally occurring substances
that interact with free radicals to decreases
cellular damage Retinoids, beta-carotene,
ascorbic acid, alpha-tocopherol Clinical
trials have not clearly proven their efficacy
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Lichen Planus
most common dermatologic disease to affect oral
cavity W gt M middle age adults
ETI unknown , ? Immune system CLINICAL
1. Reticular usually asymptomatic, typically
bilateral irregularly shaped white plaques (
Wickhams straie ) on BM ( location may change
with time ) 2. Erosive painful debilitating,
may involve entire oral cavity atrophic
ulcerated patches with white halo
Tx flucinonide ointment Orabase clobetasol
Orabase Steroids, Cyclosporine, Retinoids, Aloe
PROGNOSIS good, 1 to 5 ? SCCA
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Audit of Clinical Information Diagnosis
Supplied to Pathologist following Bx of
SCCA University of Maryland Medical
Systems Mac Whitesides DMD, MMSc MSDA vol.
38, no. 2 Sept. 1995 p.63-65
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Objective Attempt to compare correlate cases
that have the histopathologic diagnosis of oral
SCCA with the data submitted by the clinician to
the oral pathologist

vs
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Classification of Malignancies
SCCA 85 Verrucous 4 Sarcomas 6 BCCA 4 SGT
5 Lymphoma 1 Met. Tumors 5 Myeloma 1
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Clinical Factors on Bx Form
Race 82/85 96 Age 80/85 94 Site
of Lesion 80/85 94 Duration of
Lesion 55/85 65 Size of Lesion 49/85 58
Tob use 27/85 32 ETOH use 19/85 22
Presence of Pain 6/85 7
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Clinical Factors Vs Correct Diagnosis
Clinical Hx Number Clinical Diagnosis
Grade Cases M NM Excellent 17 16 1 94 G
ood 44 41 3 93 Fair 14 11 3 79 Poor 10
8 2 80
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Dr. Mac Whitesides 1100 Lake Hearn Drive Ste
160 Atlanta GA 30342
Drmac_at_bellsouth.net