Clinical Presentation of Oral Mucosal Premalignant Lesions

This chapter is concerned with the clinical presentation of premalignant oral mucosal lesions and identification of lesions as high or low risk for malignant transformation. In 2005, the WHO renamed the premalignant lesions as “oral potentially malignant disorders”, a term that suggests malignant transformation may not be an inevitable consequence, rather a possibility, and may occur at a site distinct from the original presenting lesion. Evidence suggests that for dysplastic oral potentially malignant lesions, approximately 40% change very little with time, 20% can regress spontaneously and a further 20% may increase in size. Overall, 20% are at risk of malignant transformation. Unfortunately there are currently no highly sensitive or specific clinical or molecular markers available that can accurately predict which malignant lesions are likely to transform, and management decisions are based on a number of clinical and pathological features of individual lesions and changes in these features over time. Accurately describing the clinical appearance of lesions is critical for communication with colleagues and for individual clinicians to follow up patients longitudinally.