A routine part of an oral examination should be inspection not only of the teeth and gums but also of the soft tissues in and around the mouth.
Dentists look for abnormal changes that are loosely called “lesions.” Many lesions are innocuous and can be easily diagnosed and named based upon their appearance alone.
However, some lesions are not as easy to identify and require additional diagnostic steps, such as a biopsy (removal of a piece of the lesion to examine under a microscope). A small percentage of these lesions may be premalignant or even malignant.
Frequently Asked Questions
Premalignant or precancerous (also referred to as “potentially malignant”) oral lesions involve the skin lining of the mouth (known as the epithelium) and may be at risk for becoming (transforming into) an oral cancer, although it is difficult to predict which lesions will transform and how long it will take.
As we grow older our risk of developing cancer increases. The same is true for premalignant lesions.
Most lesions are detected in people over the age of 40 and those with similar risk factors for oral cancer, such as tobacco and/or heavy alcohol use, although such lesions can also be found in younger individuals and/or those without classic risk factors.
Premalignant lesions and early cancers are usually asymptomatic (i.e. the patient has no pain and they don’t even know they have a lesion), so their detection is contingent upon a careful soft tissue examination by a dentist/doctor.
This examination must include the inside and outside of the lips, the cheeks (buccal mucosa), the sides and under surface of the tongue, the floor of mouth, the gums, the roof of the mouth (palate), the back of the mouth/top of the throat (oropharynx).
Most oral lesions are traumatic in nature and have no potential for cancer. However, some oral lesions have an appearance which may raise suspicion by the dentist.
It is recommended to seek medical advice if you have patches that are, red, white or mixed red/white in colour, or that may also be ulcerated (ie an area where the lining epithelium is lost), especially when found on “high-risk” sites such as the side (lateral surface), underside of the tongue (ventral surface), floor of mouth, or at the back of mouth/top of the throat (oropharynx).
Lesions with a red component carry the highest potential for being premalignant or becoming malignant. However, it is essential to establish an accurate diagnosis for all lesions that raise suspicion.
Following your initial consultation with Dr McHugh, a small piece of the lesion is removed under local anaesthesia (biopsy) and submitted to a pathologist for microscopic examination.
There are three possible outcomes: benign (most frequently), premalignant, or cancer.
The pathology report will use pathologic diagnoses such as epithelial hyperplasia/hyperkeratosis or other benign diagnoses, epithelial dysplasia (for premalignant lesions), or squamous cell carcinoma (the most common type of cancer seen in the oral cavity).
In epithelial dysplasia, the cells making up the layers of the epithelium look abnormal (atypia), and depending on the amount of abnormal cells seen microscopically, dysplasia may be graded as mild, moderate, severe, or carcinoma in situ (where the atypical cells are in all layers of the epithelium).
In squamous cell carcinoma these abnormal cells are no longer confined just to the epithelium but have invaded below the epithelium into deeper tissues.
Oral premalignant lesions do not typically spread as would a cancer or an infection.
However, these lesions can transform into a cancer over time.
Many lesions do improve and in some cases may even disappear. It is certainly desirable to stop smoking for many health reasons.
Even after you stop smoking, you are still at risk for oral premalignant lesions, although your risk will decrease over time.
No. Biopsies are usually minor procedures taking only a few minutes.
Local anaesthesia is administered first, a small piece of tissue is taken, some pressure is applied to stop any minor bleeding, and the area may feel a little sore and usually heals without complications.
Yes. Sometimes lesions recur. Sometimes new lesions develop at other sites in the oral cavity. Repeated examinations are essential.