• Shruti GOCHHWAL

Premalignant Lesions – A Stairway To Cancer

Your oral cavity health is an important indicator of your overall well-being. As children, we come across many Oral Submucous Fibrosis pictures in our science textbooks and labs. For those who may have forgotten, the oral cavity consists of the lips and roof of the mouth. It also includes cheek lining, front part of the tongue, gums, floor of the mouth, and the area behind your wisdom teeth.

The oral cavity is at risk of developing several debilitating conditions that may either arise naturally, or maybe a result of bad habits like excessive tobacco consumption, smoking, and the like. Lesions in the oral cavity like oral submucous fibrosis affect 12.6 % of Indian males. Here is all you need to know about it.

What Are Premalignant Conditions of Oral Cavity?

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Woman with hand on cheek, Credit: Pixabay


Precancerous or premalignant condition is a state that is at risk of developing cancer. Premalignant lesions of the oral cavity usually develop in the skin lining of your mouth (epithelium). Some of the lesions are easily diagnosed and remain harmless, but others can turn into oral cancer.

The lesions are detected and diagnosed in people who habitually consume alcohol, tobacco, or chew betel leaves. At the same time, they can also develop naturally in younger persons not having such habits. Premalignant lesions of the oral cavity are usually marked by an absence of any symptoms in the earlier stages. A close examination of the oral cavity will reveal whether the lesion is malignant or not.

How to Detect Malignant Lesions

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Doctors in operation, Credit: Pixabay


Malignant lesions are characterised by red or white patches or are in an area where the skin lining of the mouth is lost. They are generally found under the tongue, floor of the mouth, at the back of the mouth, and the topmost area of the throat.

Some reddish and white patches in the mouth with no prior cause can also be malignant. These patches cannot be wiped off with a tissue. Lesions that are prominently red carry the highest chances of developing cancer or being malignant.

Types of Premalignant Conditions of Oral Cavity

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Person smoking, Credit: Pixabay


There are six main potentially malignant complications that may or may not develop into cancer.

  1. Erythroplakia

  2. Leukoplakia

  3. Oral submucous fibrosis

  4. Palatal lesion of reverse cigar smoking

  5. Oral lichen planus 

1.  Erythroplakia

A rare condition that is usually characterised by a bright red component. It has well-defined boundaries and a velvety surface texture. It can be detected in heavy smokers and those who consume excessive amounts of alcohol. This complication in the oral cavity immediately demands a biopsy.

2.  Leukoplakia

The lesion is prominently white in colour and develops on the tongue. It can neither be wiped or scraped away. It is seen in those who regularly indulge in tobacco (guthka) chewing. Prevalent in India, this type of lesion is detected more commonly in males than females.

3.  Oral Submucous Fibrosis

It is a premalignant condition that is commonly seen in people who habitually chew betel quid consisting of areca nuts. The lesion is characterized by chronic inflammation, and abnormal accumulation of collagen in the oral tissues. Patients with oral submucous fibrosis find it extremely difficult to open their mouth. If detected at an early stage, followed by quitting the habit of tobacco/ betel nut chewing, the condition can be resolved.

4.  Palatal Lesion of Reverse Cigar Smoking

People in South American and South Asian countries indulge in ‘reverse smoking’. They insert the end of the cigar or cigarette which is lit into their mouth. The excessive heat alters the tissue lining inside the mouth. It results in a palatal lesion which has the potential to become malignant.

5.  Oral Lichen Planus

It is an inflammatory lesion that is characterized by prominently white and lacy patches, tissues that appear red and swollen, or sometimes open sores. The internal membrane of the mouth is severely affected in this condition. Symptoms include burning and pain in the affected area.

On the whole, premalignant lesions, if diagnosed and detected early, can save you from developing mouth cancer. While they may develop naturally in some, others who are predisposed to habits like tobacco, alcohol consumption and smoking should try to quit these habits as early as possible. For severe cases, surgical incision and laser ablation remain the two most widely used treatments.

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