What is a Premalignant lesion?

  • A premalignant or precancerous lesion is an abnormality in a tissue area which is just a step away form cancer.  

  • Not all premalignant lesions change to cancer, but most have greater potential for doing so than normal tissues.

  • There are many varieties of premalignant lesions, but the most important one, especially for the Indian populace, is leukoplakia.







What is Leukoplakia?
Leukoplakia is a term used by doctors to describe white patches or plaques on the mucous membranes or inner linings the mouth or the oral cavity, the anal canal or anus, and the genitals. The hallmark of these white patches is that they cannot be rubbed off.

20% of leukoplakic patches show dysplasia (decrease in differentiation of a cell, i.e., the cell loses its trademark shape and specific functional abilities which were originally designated to it).

15% of these dysplastic patches change to carcinoma-in-situ (cancer restricted only to the inner most lining of the involved tissue).

3-6% develop invasive cancer (cancer penetrating deeper than the inner most lining), usually of the squamous variety (squamous cell carcinomas are cancers derived from the flat, scale like cells which usually form lining tissues, called squamous cells).




How is Leukoplakia detected?
Leukoplakia in the oral cavity (the commonest place in Indians) is obvious as a white patch inside the mouth, located anywhere. The buccal mucosa or inner cheek, the tongue and the lips (inner surface) are common sites. These can be easily be picked up during daily oral self examination (for the procedure, see the chapter on Oral Self Examination in Detection Techniques).

If you still feel unsure, your dentist or ENT surgeon maybe able to help you pick up such lesions early. Visit them regularly to keep a tab on your oral health.

Leukoplakia of other areas, such as in the anal canal, or in the urethra, although easily identified, is relatively picked up late, because they are usually incidental discoveries by clinicians, and self examination of such areas is either impossible or not carried out routinely.




How is Leukoplakia treated?

  • Abstinence from alcohol and tobacco is an important step in self control and reduces the chances of developing premalignant leukoplakia.
  • Surgery is another method to remove a patch of leukoplakia. This surgical removal of a leukoplakic patch is known as excision.
  • The term laser stands for Light Amplification by Stimulated Emission of Radiation. Laser light is a highly focused and powerful beam of light energy that is used in medicine for very precise surgical work, such as repairing a damaged retina in the eye, cutting through tissue (replacing a scalpel), or vaporizing a cancer of the cervix. It is also very useful in cancer of voice box, small cancers in the mouth, or on the skin. Surgery can be less complicated with laser . For example, with fiber optics, light can be directed to many parts of the body without making a large incision and without damaging surrounding normal tissues. Laser surgery is very useful in removing leukoplakic patches, without causing excessive scarring.
  • Cryosurgery involves the use of a liquid nitrogen spray or a very cold probe to freeze and kill abnormal cells. This technique is sometimes used to treat precancerous conditions such as those affecting the cervix and the leukoplakia . Cryosurgery is also being tried as a treatment of some cancers like prostate cancers. Usually cryosurgery involves little or no pain.
  • Oral retinoids are basically derivatives of Vitamin A, derived synthetically or semisynthetically and naturally. They act as antioxidants, that is, they prevent damage due to toxic free radicals which cause oxidative injury.


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