Clinical and Histopathological Aspects of Premalignant Lesions

  • Jolán Bánóczy
Part of the Developments in Oncology book series (DION, volume 20)


Carcinoma of the oral cavity may be associated with or preceded by lesions that carry a serious risk of malignant changes. These so-called precancerous lesions may precede the development of carcinoma by months or by years. The WHO has defined a precancerous lesion as “a morphologically altered tissue in which cancer is more likely to occur than in its apparently normal counterpart,” whereas a premalignant condition is defined as “a generalized state associated with a significantly increased risk of cancer” [1]. According to the present viewpoints, the following pathological lesions and conditions are considered premalignant: leukoplakia, erythroplakia, and submucous fibrosis.


Oral Mucosa Buccal Mucosa Premalignant Lesion Clinical Type Epithelial Dysplasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Pindborg JJ. Oral Cancer and Precancer. Bristol: Wright & Sons, 1980.Google Scholar
  2. 2.
    Buchner A, Hansen LS. Pigmented nevi of the oral mucosa: A clinicopathologic study of 32 new cases and review of 75 cases from the literature. Part 1. Oral Surg (48): 131–142, 1979.Google Scholar
  3. 3.
    Buchner A, Hansen LS. Pigmented nevi of the oral mucosa: A clinicopathologic study of 32 new cases and review of 75 cases from the literature. Part 2. Oral Surg (49): 55–62, 1980.PubMedGoogle Scholar
  4. 4.
    Schwimmer E. A szájüreg és nyelv nyálkahártya némely ritka kóralakjáról. Orv Egyesület Evkönyve, 1877, 48 sz.Google Scholar
  5. 5.
    WHO Collaborating Centre for Oral Precancerous Lesions. Definition of leukoplakia and related lesions: An aid to studies on oral precancer. Oral Surg (46): 518–539, 1978.Google Scholar
  6. 6.
    Atkinson L, Chester IC, Smith FG, Ten Seldam REJ. Oral cancer in New Guinea. A study in demography and etiology. Cancer (17): 1289–1298, 1964.PubMedGoogle Scholar
  7. 7.
    Pindborg JJ, Joist O, Renstrup G, Roed-Petersen B. Studies in oral leukoplakia: A preliminary report on the prevalence of malignant transformation in leukoplakia based on a follow-up study of 248 patients. J Amer Dent Ass (76): 767–771, 1968.PubMedGoogle Scholar
  8. 8.
    Wahi PN, Mitai VP. Epidemiological study of precancerous lesions of the oral cavity: A preliminary report. Indian J Med Res (58): 1361–1391, 1970.PubMedGoogle Scholar
  9. 9.
    Bruszt P. Stomato-onkologische Reihenuntersuchungen in sieben Gemeinden Südungarns. Schw Mschr Zahnheilk (72): 758–766, 1962.Google Scholar
  10. 10.
    Axéll T. A preliminary report on prevalence of oral mucosal lesions in a Swedish population. Community Dent Oral Epidemiol (3): 143–145, 1975.PubMedGoogle Scholar
  11. 11.
    Gerry RG, Smith ST, Calton ML. The oral characteristics of Guamanians including the effects of betel chewing on the oral tissues. Oral Surg (5): 762–781, 1952.PubMedGoogle Scholar
  12. 12.
    Mehta F, Sanjana MK, Shroff BC, Doctor RHC. Incidence of leukoplakia among “pan” (betal leaf) chewers and “bidi” smokers: A study of a sample survey. Indian J Med Res (49): 393–398, 1961.Google Scholar
  13. 13.
    Pindborg JJ, Kalapessi HK, Kale SA, Singh B, Talverkhan B. Frequency of oral leukoplakias and related conditions among 10,000 Bombayites. J All India Dent Ass (37): 1–2, 1965.Google Scholar
  14. 14.
    Pindborg JJ, Chawla TN, Misra RK, Nagpaul RK, Gupta P. Frequency of oral carcinoma, leukoplakia, leukoedema, leukokeratosis, submucous fibrosis and lichen planus in 10,000 Indians in Lucknow, Uttar Pradesh, India. J Dent Res (44): 615–618, 1965.Google Scholar
  15. 15.
    Pindborg JJ, Rhatt M, Devanath KR, Narayana HR, Ramachandra S. Frequency of oral white lesions among 10,000 individuals in Bangalore, South India. Indian J Med Sci (20): 349–352, 1966.PubMedGoogle Scholar
  16. 16.
    Zachariah J, Matthew B, Varma NAR, Iqbal AM, Pindborg JJ. Frequency of oral mucosal lesions among 5,000 individuals in Trivandrum, South India. J All India Dent Ass (38): 290–294, 1966.Google Scholar
  17. 17.
    Pindborg JJ, Barmes OD, Roed-Petersen B. Epidemiology and leukoedema among Papuans and New Guineans. Cancer (22): 379–384, 1968.PubMedGoogle Scholar
  18. 18.
    Bánóczy J, Radnai T, Reményi I. Módszertani tapasztalataink Dunakeszi és Felsógöd lakos-ságán végzett stomato-onkológiai szüróvizsgálatok alapján. Fogorv Szle (62): 118–122, 1969.Google Scholar
  19. 19.
    Mehta F, Pindborg JJ, Gupta PC, Daftary DK. Epidemiologic and histologic study of oral cancer and leukoplakia among 50,915 villagers in India. Cancer (24): 832–849, 1969.PubMedGoogle Scholar
  20. 20.
    Gangadarhan P, Paymaster JC. Leukoplakia, an epidemiologic study of 1504 cases observed at the Tata Memorial Hospital, Bombay, India. Brit J Cancer (25): 657–668, 1971.Google Scholar
  21. 21.
    Sonkodi I, Tóth K. Szegedi textilipari munkások stomato-onkológiai vizsgálata. Fogorv Szle (67): 165–169, 1974.Google Scholar
  22. 22.
    Silverman S, Bhargava K, Mani N, Smith LW, Malaowalla MA. Malignant transformation and natural history of oral leukoplakia in 57,518 industrial workers of Gujaret, India. Cancer (38): 1790–1795, 1976.PubMedGoogle Scholar
  23. 23.
    Wilsch L, Hornstein OP, Brüning H, Schwipper V, Lösel F, Schönberger A, Gunselmann W, Prestele H. Orale Leukoplakien II. Ergebnisse einer 1 jährigen poliklinischen Pilotstudie. Dtsch zahnärztl Zschr (33): 132–142, 1978.Google Scholar
  24. 24.
    Silverman S, Rozen RD. Observations on the clinical characteristics and natural history of oral leukoplakia. J Amer Dent Ass (76): 772–776, 1968.PubMedGoogle Scholar
  25. 25.
    Roed-Petersen B. Cancer development in oral leukoplakia. Follow-up of 331 patients. J Dent Res (50): 711–716, 1971.Google Scholar
  26. 26.
    Mela F, Mongini F. La terapie della lesioni leucoplasiche del cavo orale (In base di resultati di uno studio su 141 casi controllati a distanza dall’ intervento). Minerva Stomat (15): 804–811, 1966.Google Scholar
  27. 27.
    Bánóczy J: Follow-up studies in oral leukoplakia. J. Max.-Fac. Surg. (5): 69–75, 1977.Google Scholar
  28. 28.
    Baric JM, Alman JE, Feldman RS, Chauncey HH. Influence of cigarette, pipe, and cigar smoking, removable partial dentures, and age on oral leukoplakia. Oral Surg (54): 424–429, 1982.PubMedGoogle Scholar
  29. 29.
    Roed-Petersen B, Gupta PC, Pindborg JJ, Singh B. Association between oral leukoplakia and sex, age and tobacco habits. Bull Wld Hlth Org (47): 13–19, 1972.Google Scholar
  30. 30.
    Mehta S, Daftary DK, Shroff BC, Sanghvi LD. Clinical and histologic study of oral leukoplakia in relation to habits. A five-year follow-up. Oral Surg (28): 372–388, 1969.PubMedGoogle Scholar
  31. 31.
    Pindborg JJ, Roed-Petersen B, Renstrup G. Role of smoking in floor of the mouth leukoplakias. J. Oral Path (1): 22–29, 1972.PubMedGoogle Scholar
  32. 32.
    Lain E. Electrogalvanic lesions of the oral cavity produced by metallic dentures. J Amer Dent Ass (100): 717–723, 1933.Google Scholar
  33. 33.
    Ullmann K. Leukoplakia caused by electrogalvanic current generated on the oral cavity. Wien klin Wschr (45): 840–852, 1932.Google Scholar
  34. 34.
    Bánóczy J, Roed-Petersen B, Pindborg JJ, Inovay J. Clinical and histologic studies on electrogalvanically induced oral white lesions. Oral Surg (48): 319–323, 1979.PubMedGoogle Scholar
  35. 35.
    Jepsen A, Winther JE. Mycotic infection in oral leukoplakia. Acta Odont Scand (23): 239–256, 1965.PubMedGoogle Scholar
  36. 36.
    Daftary DK, Mehta FS, Gupta PC, Pindborg JJ. The prevalence of Candida in 723 oral leukoplakias among Indian villagers. Scand J Dent Res (80): 75–79, 1972.PubMedGoogle Scholar
  37. 37.
    Restrup G. Occurrence of Candida in oral leukoplakias. Acta Path Microbiol Scand B (78): 421–424, 1970.Google Scholar
  38. 38.
    Burkhardt A, Seifert G. Morphologische Klassifikation der oralen Leukoplakien. Dtsch Med Wschr (102): 223–229, 1977.PubMedGoogle Scholar
  39. 39.
    Burkhardt A. Der Mundhöhlenkrebs und seine Vorstadien, G. Fischer. New York: Stuttgart, 1980.Google Scholar
  40. 40.
    Bánóczy J, Sugár L. Progressive and regressive changes in Hungarian oral leukoplakias in the course of longitudinal studies. Community Dent Oral Epidemiol (3): 194–197, 1975.PubMedGoogle Scholar
  41. 41.
    Clemmesen J. Statistical Studies in the Etiology of Malignant Neoplasms. København: Munksgaard, 1965.Google Scholar
  42. 42.
    Roed-Petersen B, Renstrup G. A topographical classification of the oral mucosa suitable for electronic data processing (its application to 560 leukoplakias). Acta Odont Scand (27): 681–695, 1969.PubMedGoogle Scholar
  43. 43.
    World Health Organization. Oral Mucosa Manual, Geneva, 1980.Google Scholar
  44. 44.
    Mehta FS, Pindborg JJ, Hamner JE. Oral Cancer and Precancerous Conditions in India. København: Munksgaard, 1971.Google Scholar
  45. 45.
    Hornstein OP. Leukoplakien der Mundschleimhaut. Zlbl Haut u Geschlechtskrank. (139): 1–18, 1977.Google Scholar
  46. 46.
    Hornstein OP. Orale Leukoplakien I. Klassifikation, Differentialdiagnose, Atiologische Bedingungen der Kanzerisierung, Prognose. Dtsch zahnärztl Z (32): 497–505, 1977/b.PubMedGoogle Scholar
  47. 47.
    Sugár L, Bánóczy J. Vizsgálatok a szájnyálkahártya praecancerosisairól. Fogorv Szle (50): 347–353, 1957.Google Scholar
  48. 48.
    Sugár L, Bánóczy J. Untersuchungen bei Präkanzerose der Mundschleimhaut. Dtsch. Zahn-, Mund-Kieferheilk (30): 132–140, 1959.Google Scholar
  49. 49.
    Pindborg JJ, Renstrup G, Poulsen HE, Silverman S. Studies in oral leukoplakias: V. Clinical and histological signs of malignancy. Acta Odont Scand (21): 407–414, 1963.PubMedGoogle Scholar
  50. 50.
    Fischman SL, Ulmansky M, Sela J, Bab I, Gazit D. Correlative clinico-pathological evaluation of oral premalignancy. J Oral Pathol (11): 283–289, 1982.PubMedGoogle Scholar
  51. 51.
    Fasske E, Hahn W, Morgenroth K, Themann H. Die Leukoplakie der menschlichen Mundschleimhaut. Mitteilungsdienst (2): 7–24, 1958.Google Scholar
  52. 52.
    Popescu V, Sturza M. Stomatoscopy in the early diagnosis of buccal cancer. Int Dent J (18): 694–707, 1968.PubMedGoogle Scholar
  53. 53.
    Sigurdson A. Metodundersökninger vid oral slemmhimmediagnostik. Thesis, Stockholm, 1977.Google Scholar
  54. 54.
    Papanicolaou G, Traut W. Diagnosis of urterine cancer by the vaginal smear. New York, Commonwealth Fund, 1943.Google Scholar
  55. 55.
    Bánóczy J. Exfoliative cytologic examinations in the early diagnosis of oral cancer. Int Dent J (26): 398–404, 1976.PubMedGoogle Scholar
  56. 56.
    Mehta FS, Daftary DK, Sahiar BE. A correlative histocytological study of epithelial atypia in leukoplakia and submucous fibrosis lesions amongst Indian villagers in a mass screening programme. Indian J Cancer (7): 18–25, 1970.PubMedGoogle Scholar
  57. 57.
    Dabelsteen E, Roed-Petersen B, Smith J, Pindborg JJ. The limitation of exfoliative cytology for the detection of epithelial atypia in oral leukoplakias. Brit J Cancer (25): 21–24, 1971.PubMedGoogle Scholar
  58. 58.
    Bánóczy J, Rigó O. Comparative cytologic and histologic studies in oral leukoplakia. Acta Cytol (20): 308–312, 1976.PubMedGoogle Scholar
  59. 59.
    Bánóczy J. Exfoliative cytological changes in oral leukoplakias. J Dent Res (48): 17–21, 1969.PubMedGoogle Scholar
  60. 60.
    Silverman J, Galante M. Oral Cancer. San Francisco: University of California, 1972.Google Scholar
  61. 61.
    Shafer WG, Waldron CA. A clinical and histopathological study of oral leukoplakia. Surg/ Gynecol Obstetr (112): 411–420, 1961.Google Scholar
  62. 62.
    Waldron CA, Shafer WG. Leukoplakia revisited. A clinicopathologic study 3256 oral leukoplakias. Cancer (36): 1386–1392, 1975.PubMedGoogle Scholar
  63. 63.
    Grässel-Pietrusky R, Hornstein OP. Histologische Klassifikation oraler Präkanzerosen. Dtsch A Mund-Kiefer-Gesichts-Chir (6): 343–351, 1982.Google Scholar
  64. 64.
    Kramer IRH, Lucas RB, El-Labban N, Lister L. A computer-aided study on the tissue changes in oral keratoses and lichen planus, and an analysis of cases grouping by subjective and objective criteria. Brit J Cancer (24): 407–426, 1970.PubMedGoogle Scholar
  65. 65.
    Kramer IRH, Lucas RB, El-Labban N, Lister L. The use of discriminant analysis for examining the histological features of oral keratoses and lichen planus. Brit J Cancer (24): 673–686, 1970.PubMedGoogle Scholar
  66. 66.
    Kramer IRH. Precancerous conditions of the oral mucosa. Annals R Coll Surg England (45): 3–19, 1969.Google Scholar
  67. 67.
    El-Labban N, Lucas RB, Kramer IRH. The mitotic values for the epithelium in oral keratoses and lichen planus. Brit J Cancer (25): 411–416, 1971.PubMedGoogle Scholar
  68. 68.
    Kramer IRH, El-Labban N, Sonkodi S. Further studies on lesions of the oral mucosa using computer-aided analyses of histological features. Brit J Cancer (29): 223–231, 1974.PubMedGoogle Scholar
  69. 69.
    Bánóczy J, Csiba A. Comparative study of the clinical picture and histopathologic structure of oral leukoplakia. Cancer (29): 1230–1234, 1972.PubMedGoogle Scholar
  70. 70.
    Bánóczy J, Csiba A. Occurrence of epithelial dysplasia in oral leukoplakia. Oral Surg (42): 766–774, 1976.PubMedGoogle Scholar
  71. 71.
    Haim G. Elektronenmikroskopische Untersuchungen pathologischer Verhornungsvorgänge im Epithel der Schleimhaut. Stoma (17): 292–308, 1964.Google Scholar
  72. 72.
    Silverman J. Ultrastructure studies of oral mucosa. I. Comparison of normal and hyper-keratotic human buccal epithelium. J Dent Res (46): 1433–1443, 1967.PubMedGoogle Scholar
  73. 73.
    Frithiof L. Ultrastructure of the basement membrane in normal and hyperplastic human oral epithelium compared with that in preinvasive and invasive carcinoma. Acta Path et Microb Skand (200): 1–63, 1969.Google Scholar
  74. 74.
    Frithiof L. Ultrastructural changes in the plasma membrane in human oral epithelium. J Ultrastruct Res (32): 1–17, 1970.PubMedGoogle Scholar
  75. 75.
    Frithiof L. Electron microscopic observations on structures related to the epithelial basement membranes in squamous cell carcinoma. Acta Otolaryng (73): 323–334, 1971.Google Scholar
  76. 76.
    Schenk P. Die ultrastrukturelle Morphologie normalen und pathologischen oralen Epithelien unter besonderer Berücksichtigung von dysplastischen und dyskeratotischen Veränderungen, Carcinoma in situ und invasivem Carcinoma. Thesis, Stockholm, 1975.Google Scholar
  77. 77.
    Bánóczy J, JuhászJ, Albrecht M. Ultrastructure of different clinical forms of oral leukoplakia. J Oral Pathol (9): 41–53, 1980.PubMedGoogle Scholar
  78. 78.
    Morgenroth K, Morgenroth Kjr. Untersuchungen von Mundschleimhautveränderungen mit dem Rasterelektronenmikroskop. Acta meditechn (18): 18–23, 1970.Google Scholar
  79. 79.
    Morganroth K, Morgenroth Kjr. Vergleichende stomatoskopische und rasterelektronenmik-roskopische Untersuchungen von Mundschleimhautveränderungen. Dtsch Zahnärztl Zschr (25): 199–207, 1970.Google Scholar
  80. 80.
    Matsumoto Y, Uchida T, Maruya M, Tokita M, Seto K, Watanabe Y. Scanning electron microscopic study of the human oral mucosa. J Dent Res (55): D. 176, 28, 1976.Google Scholar
  81. 81.
    Bánóczy J, Lapis K, Albrecht M. Scanning electron microscopic study of oral leukoplakia. J Oral Pathol (9): 145–154, 1980.PubMedGoogle Scholar
  82. 82.
    Frykholm O, Frithiof L, Fernström B, Moberger G, Blom S, Björn E. Allergy to copper derived from dental alloys as a possible cause of oral lesions of lichen planus. Acta derm venereol (49): 268–281, 1969.PubMedGoogle Scholar
  83. 83.
    Kövesi G, Bánóczy J. Follow-up studies in oral lichen planus. Int J Oral Surg (2): 13–19, 1973.PubMedGoogle Scholar
  84. 84.
    Lauffer J, Kuffer R. Le Lichen Plan Buccal. Paris: Masson et Cie, 1970.Google Scholar
  85. 85.
    Frithiof L, Bánóczy J. Ultrastructural observations in leukoedema exfoliativum mucosae oris (white sponge nevus). Oral Surg (41): 607–622, 1976.PubMedGoogle Scholar
  86. 86.
    Bánóczy J, Sugár L, Frithiof L. White sponge nevus: Leukoedema exfoliativum mucosae oris. Swed Dent J (66): 481–493, 1973.Google Scholar
  87. 87.
    Skach M, Svoboda O, Kubát K. Prisperich k problému leukoplakia. Acta Univ Carol Sect Med Suppl (10): 363–371, 1960.Google Scholar
  88. 88.
    Einhorn J, Wersäll J. Incidence of oral carcinoma in patients with leukoplakia of the oral mucosa. Cancer (20): 2189–2193, 1967.PubMedGoogle Scholar
  89. 89.
    Pindborg JJ, Mehta FS, Daftary DK. Incidence of oral cancer among 30,000 villagers in India in a 7-year follow-up study of oral precancerous lesions. Community Dent Oral Epidemiol (3): 86–88, 1975.PubMedGoogle Scholar
  90. 90.
    Pindborg JJ. Oral Cancer from an international point of view. J Canad Dent Ass (31): 219–226, 1965.PubMedGoogle Scholar
  91. 91.
    Mehta FS, Pindborg JJ. Spontaneous regression of oral leukoplakias among Indian villagers in a 5-year follow-up study. Community Dent Oral Epidemiol (2): 80–84, 1974.PubMedGoogle Scholar
  92. 92.
    Maerker R, Burkhardt A. Klinik oraler Leukoplakien und Präkanzerosen. Retrospektive Studie an 200 Patienten. Dtsch Z Mund-Kiefer-Gesichts-Chir (2): 206–220, 1978.Google Scholar
  93. 93.
    Pindborg JJ. Epidemiological studies of oral cancer. Intern Dent J (27): 172–178, 1977.Google Scholar
  94. 94.
    Roed-Petersen B, Renstrup G, Pinborg JJ. Candida in oral leukoplakia. Scand J Dent Res (78): 323–328, 1970.PubMedGoogle Scholar
  95. 95.
    Kramer IRH, El-Labban NG, Lee KW. The clinical features and risk of malignant transformation in sublingual keratosis. Brit Dent J (144): 171–180, 1978.PubMedGoogle Scholar
  96. 96.
    Roed-Petersen B, Bánóczy J, Pindborg JJ: Smoking habits and histological characteristics of oral leukoplakias in Denmark and Hungary. Brit J Cancer (28): 575–579, 1973.PubMedGoogle Scholar
  97. 97.
    Cawson RA. Premalignant lesions in the mouth. Brit Med Bull (31): 164–168, 1975.PubMedGoogle Scholar
  98. 98.
    Queyrat L. Erythroplasie du gland. Bull Soc Fr Dermatol Syphiligr (22): 378–382, 1911.Google Scholar
  99. 99.
    Shafer WG, Waldron CA. Erythroplakia of the oral cavity. Cancer (36): 1021–1028, 1975.PubMedGoogle Scholar
  100. 100.
    Shear M. Erythroplakia of the mouth. Int Dent J (22): 460–473, 1972.PubMedGoogle Scholar
  101. 101.
    Mashberg A. Erythroplasia—Earliest sign of asymptomatic oral cancer. J Am Dent Ass (96): 615–620, 1978.PubMedGoogle Scholar
  102. 102.
    Shafer WG. Oral carcinoma in situ. Oral Surg (39): 227–238, 1975.PubMedGoogle Scholar
  103. 103.
    Laskaris G, Bovopoulou O, Nicolis G. Oral submucous fibrosis in a Greek female. Br J Oral Surg (19): 197–201, 1981.PubMedGoogle Scholar
  104. 104.
    Pindborg JJ. Is submucous fibrosis a precancerous condition on the oral cavity? Intern Dent J (22): 474–480, 1972.Google Scholar
  105. 105.
    Wahi PN, Kapur NL, Luthra KU, Srivastava MC. Submucous fibrosis of the oral cavity: 1. Clinical features. Bull Wld Hlth Org (35): 789–792, 1966.Google Scholar
  106. 106.
    Paymaster JC. Cancer of the buccal mucosa; a clinical study of 650 cases in Indian patients. Cancer (37): 431–435, 1956.Google Scholar
  107. 107.
    Bánóczy J. Oral Leukoplakia. The Hague: Martinus Nijhoff, 1982.Google Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston 1984

Authors and Affiliations

  • Jolán Bánóczy

There are no affiliations available

Personalised recommendations