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Interventional laser surgery: An effective surgical and diagnostic tool in oral precancer management

Lookup NU author(s): Professor Peter Thomson

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Abstract

Invasive oral squamous cell carcinomas (OSCCs) are often preceded by precancerous lesions, the management of which remains controversial, polarized between active surgical excision to try to prevent malignant change or more conservative, medical or observational techniques. In order to determine the efficacy of interventional CO2 laser surgery in oral precancer management, the records of 57 consecutive laser-treated patients presenting over a 4-year period, with histologically confirmed dysplastic lesions, were reviewed. Leukoplakias were the commonest clinical lesions (69%), whilst the floor of the mouth was the most frequent anatomical site (42%). Laser surgery successfully excised 55 precancerous lesions, 11 of which exhibited more severe dysplasia or neoplasia compared with initial biopsy. Postoperative scarring and morbidity were minimal. After surgery, patients were followed for between 1 and 44 months (mean 18 months). Of these patients, 76% remained disease-free, whilst 24% developed new dysplastic lesions at distinct or multiple sites, often exhibiting increased dysplasia. Of the patients experiencing recurrence, 7% developed OSCC, whilst a further 3.5% presented with other aerodigestive tract cancers. Neither initial lesion appearance nor histological diagnosis predicted clinical behaviour. Interventional laser surgery is thus advised, in contradistinction to conservative management of oral precancers, to facilitate efficacious, low-morbidity treatment and to establish definitive histological diagnosis. As a consequence of field change carcinogenesis, regular follow up of treated precancer patients is mandatory for effective tertiary prevention.


Publication metadata

Author(s): Thomson PJ, Wylie J

Publication type: Article

Publication status: Published

Journal: International Journal of Oral and Maxillofacial Surgery

Year: 2002

Volume: 31

Issue: 2

Pages: 145-153

Print publication date: 01/01/2002

ISSN (print): 0901-5027

ISSN (electronic): 1399-0020

Publisher: Churchill Livingstone

URL: http://dx.doi.org/10.1054/ijom.2001.0189

DOI: 10.1054/ijom.2001.0189

PubMed id: 12102411


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