title: An overview of the risk factors associated with multiple oral premalignant lesions with a case report of extensive field cancerization in a female patient.
abstract: BACKGROUND
  Field cancerization is a well-known and well-documented process of malignant transformation first coined by Slaughter et al. in 1953. Tobacco chewing was associated with the greatest increase in the risk of multiple oral premalignant lesions and may be the major source of field cancerization of the oral cavity in the Indian population. The field cancerization will probably help clinicians in complementing evaluation of pathologic biopsy specimens.
  
  
  METHODS
  We present a case report of field cancerization in a 63-year-old Indian female. She presented with an intra-oral generalized hyperkeratotic verruciform type white lesions involving right and left buccal mucosa, lower labial mucosa, upper and lower vestibule, dorsal, ventral and right lateral border of the tongue, hard and soft palate. Microscopic examination revealed features of verrucous carcinoma in one area, squamous cell carcinoma in another and carcinoma in situ in other areas. Based on the overall features in various areas of the oral cavity, the lesion was diagnosed as field cancerization.
  
  
  CONCLUSIONS
  Reviewing the literature revealed the presence of a field with genetically altered cells appear to be induced by tobacco (smoking/smokeless form). The large number of premalignant cells in the fields may increase cancer risk considerably. Thus screening and monitoring of the field may have serious implications for oral cancer prevention.
authors.affiliation: Department of Oral Pathology and Microbiology, Babu Banarasi Das College of Dental Sciences, Lucknow, India.
authors.forename: Gadiputi
authors.initials: G
authors.lastname: Sreedhar
authors.affiliation: Department of Oral Medicine, Babu Banarasi Das College of Dental Sciences, Lucknow, India.
authors.forename: Masineni
authors.initials: M
authors.lastname: Narayanappa Sumalatha
authors.affiliation: Department of Oral Pathology and Microbiology, Babu Banarasi Das College of Dental Sciences, Lucknow, India.
authors.forename: Deepika
authors.initials: D
authors.lastname: Shukla
mesh_terms: D002277:Carcinoma / Q000473:pathology*; D002278:Carcinoma in Situ / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000473:pathology; D018289:Carcinoma, Verrucous / Q000473:pathology; D002471:Cell Transformation, Neoplastic; D005260:Female; D006801:Humans; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology*; D011230:Precancerous Conditions / Q000473:pathology*; D012307:Risk Factors; D014030:Tobacco, Smokeless / Q000009:adverse effects
keywords: field cancerization; oral cancer; premalignant lesions; tobacco chewing