Management of oral epithelial dysplasia:: a review

A systematic review of the management of oral dysplasia was undertaken. Medical, nonsurgical management strategies for the treatment of dysplastic lesions of the oral mucosa have shown promising results. However, because of the limited periods of follow-up reported in these studies, it remains unclear as whether resolution of dysplasia and, subsequently, prevention of future development of squamous cell carcinoma (SCC) would actually be a long-term benefit of these interventions. Therefore, no recommendations can be provided at this stage with regard to medical management of oral dysplastic lesions. Because of the lack of randomized controlled trials that have shown effectiveness in the prevention of malignant transformation, no recommendations can be provided for specific surgical (including lasers) interventions of dysplastic oral lesions either. Nevertheless, guidelines are needed for the width of the margin that should be observed when removing a dysplastic lesion. Likewise, guidelines are needed with regard to the length of postsurgical follow-up and the intervals of such follow-up visits. At present, no consensus exists about the usefulness of diagnostic aids such as Toluidine blue and cytobrush in the management of oral dysplastic lesions. Furthermore, there is a need for a more objective grading scale of epithelial dysplasia. Such a scale will most likely include or may be entirely based on a set of molecular markers. Until now, no single molecular pathway has been identified as the primary factor in progression of dysplasia to squamous cell carcinoma. Because tobacco habits seem to play a major etiologic role in the majority of oral premalignant lesions, cessation of such habits remains a key issue in both the management and the prevention of premalignant lesions of the oral mucosa.