Melbourne Dental School, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia.
J Oral Pathol Med. 2024 Sep;53(8):495-501. doi: 10.1111/jop.13573. Epub 2024 Aug 5.
This manuscript critically examines the current classification of oral potentially malignant disorders, questioning the practicality and implications of labeling such a large population as precancerous, given that the actual progression to oral cancer is significantly low for most disorders. The paper advocates for a revised classification system that accurately reflects the varying malignancy risks associated with different disorders. It suggests a reassessment of the diagnostic and management approaches to mitigate overdiagnosis and alleviate patient burdens. We propose categorizing diseases with oral malignant potential as follows: Oral Precancerous Diseases, encompassing high-risk lesions and conditions like erythroplakia, non-homogeneous leukoplakia, proliferative leukoplakia, and actinic keratosis; Oral Potentially Premalignant Diseases, covering lesions, conditions, and systemic diseases with distinct oral manifestations harboring a limited or undefined risk of transformation, such as homogeneous leukoplakia, oral submucous fibrosis, oral lichenoid diseases, chronic hyperplastic candidosis, keratosis of known aetiology (smokeless tobacco, khat), palatal lesions in reverse smokers, and dyskeratosis congenita; and Systemic Conditions with Oral Malignant Potential including Fanconi's anemia, xeroderma pigmentosum, and chronic immunosuppression (including patients post-bone marrow transplantation), which are associated with an increased risk of oral cancer without preceding precursor lesions. We provide illustrative examples to demonstrate how this framework offers practical guidance for research, policy-making, and clinical practice.
这篇手稿批判性地审视了当前口腔潜在恶性疾病的分类，质疑将如此庞大的人群标记为癌前病变的实用性和影响，因为大多数疾病向口腔癌的实际进展率非常低。本文主张采用一种新的分类系统，准确反映不同疾病相关的恶性风险变化。它建议重新评估诊断和管理方法，以减少过度诊断并减轻患者负担。我们建议将具有口腔恶性潜能的疾病分类如下：口腔癌前疾病，包括高风险病变和情况，如红斑、非均质性白斑、增殖性白斑和光化性角化病；口腔潜在癌前疾病，涵盖具有明确或有限恶变风险的病变、情况和系统性疾病，如均质性白斑、口腔黏膜下纤维化、口腔扁平苔藓、慢性增生性念珠菌病、已知病因角化病（无烟烟草、恰特草）、反向吸烟者的腭部病变和先天性角化不良；以及具有口腔恶性潜能的系统性疾病，包括范可尼贫血、着色性干皮病和慢性免疫抑制（包括骨髓移植后的患者），这些疾病在没有前驱病变的情况下增加了口腔癌的风险。我们提供了说明性的例子，展示了这一框架如何为研究、决策和临床实践提供实用的指导。
