Management of Moderate Dysplasia of the Oral Cavity

Abstract

Moderate dysplasia of the oral cavity has an intermediate propensity to progress to malignancy, but no biomarkers exist that accurately predict progression of a given lesion. Furthermore, no prospective randomized controlled trials have yet been conducted to determine optimal management of oral premalignant lesions. Management of moderate dysplasia therefore remains controversial. In this chapter, a review of the literature regarding observation and surgical excision of moderate dysplasia is presented. Data regarding the rates of malignant transformation of moderate dysplasia with or without surgical intervention are reviewed. Conflicting data regarding the effects of surgical intervention on subsequent malignant transformation and recurrent dysplasia are also examined. Lastly, evidence regarding the risks of “under-diagnosis” of dysplastic lesions, and the importance of this phenomenon in the context of management of moderate dysplasia, is discussed. The author concludes that, though the quality of available evidence is low, moderate dysplasia may be associated with an increased risk of subsequent malignant transformation. Surgical resection may be effective in reducing, but not eliminating, the risk of transformation. Furthermore, all patients with moderate dysplasia should undergo continued surveillance regardless of initial management strategy, given the persistent risks of recurrence and malignancy with or without surgical intervention.