title: Recurrence patterns and management of oral cavity premalignant lesions.
abstract: OBJECTIVE
  To gain an understanding of head and neck mucosal premalignant recurrence and progression based on histology, treatment modality, and risk factors.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Patients who were followed or treated for oral cavity dysplasia/carcinoma in situ.
  
  
  METHODS
  Comparisons with clinical features, degree of dysplasia, anatomical location, rate of recurrences as well as malignant transformation and overall outcome were made.
  
  
  RESULTS
  Of the 136 patients who were included in the study, 20% (n = 27) initially presented with mild dysplasia, 39% (n = 53) with moderate dysplasia, 21% (n = 29) with severe dysplasia, and 20% (n = 27) with carcinoma in situ. Wide local excision (HR 0.54, p = 0.05) was associated with reduced local recurrence in comparison to observation. In comparison to observation, both wide local excision (HR 0.43, p = 0.04) and CO(2)/NO Yag laser treatment (HR 0.14, p = 0.02) of dysplastic lesions significantly reduced progression to cancer. Management of mild dysplasia included observation (n = 13), excision (n = 10) and laser therapy (n = 3). Six of the 13 observed patients suffered a premalignancy recurrence, whereas only 4 of the 13 patients who underwent excision/laser treatment experienced a recurrence. Similarly, 5/13 observed patients eventually progressed to malignancy in comparison to only 2/13 patients who underwent initial excision/laser treatment.
  
  
  CONCLUSIONS
  Wide excision and/or ablation of head and neck mucosal premalignancy is more effective than observation in preventing recurrence of premalignancy and progression to malignancy. Mild dysplasia has a potentially high rate of recurrence and progression to malignancy when observed, and may be treated by wide excision or ablation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287-0910, USA. takis.demetri@gmail.com
authors.forename: Demetri
authors.initials: D
authors.lastname: Arnaoutakis
authors.forename: Justin
authors.initials: J
authors.lastname: Bishop
authors.forename: William
authors.initials: W
authors.lastname: Westra
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Califano
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology* / Q000628:therapy; D009364:Neoplasm Recurrence, Local; D011230:Precancerous Conditions / Q000473:pathology* / Q000628:therapy
keywords: Dysplasia; Excision; Oral cancer; Premalignancy; Recurrence