A survey of the current approaches to diagnosis and management of oral premalignant lesions.
BACKGROUND
Early diagnosis of oral premalignant lesions (OPLs) and oral squamous cell carcinoma facilitates treatment with less aggressive approaches and results in a better prognosis. The authors conducted a study to identify current practices in the diagnosis and management of these oral lesions by oral medicine professionals.


METHODS
The authors sent a questionnaire to 176 diplomates of the American Board of Oral Medicine and asked them to complete the questionnaires and return them by mail.


RESULTS
The initial clinical approach taken by most of the responders included visual examination, elimination of possible local causes and two-week follow-up. Adjuvant clinical tests included toluidine blue, oral brush biopsy and exfoliative cytology. If there was no clinical improvement after two weeks, most responders recommended that a biopsy be performed. Induration, red component, nonhomogeneous surface and ulceration were characteristics of lesions that increased the responders' decisions to perform a biopsy. Lesion symptoms and location also contributed to their decisions to perform a biopsy. Follow-up more frequently than twice a year was recommended for red lesions, lesions with histologically confirmed dysplasia or both. Most clinicians recommend a biopsy during follow-up of an OPL whenever the lesion changes in appearance.


CONCLUSIONS
The findings of this survey may provide background for initial guidelines to be used by oral practitioners to diagnose and manage OPL. Clinicians' awareness of the complexity of OPL diagnosis and management is important, and referral to an experienced provider is recommended.
Epstein
Joel B
JB
Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois at Chicago, 801 S. Paulina Street, Chicago, IL 60612, USA. jepstein@uic.edu
Gorsky
Meir
M
Fischer
Dena
D
Gupta
Anurag
A
Epstein
Matthew
M
Elad
Sharon
S
D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000628:therapy; D003581:Cytodiagnosis; D042241:Early Diagnosis; D004919:Erythroplasia / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D007972:Leukoplakia, Oral / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000628:therapy; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000628:therapy; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires