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Epithelial dysplasia must be treated
Oral Oncology xxx (2016) xxx–xxx
Contents lists available at ScienceDirect
Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology
Letter to the editor Epithelial dysplasia must be treated
Dear Sir, We read with great interest the article titled, ‘‘Should severe epithelial dysplasia be treated?” by Zhang et al. [1]. We appreciate the authors’ efforts to find an answer to this most difficult question in the field of oral oncology, and would like to share our views on this subject. While supporting Zhang et al.’s views on treating severe epithelial dysplastic lesions, we believe that all epithelial dysplastic lesions, irrespective of severity (i.e., mild, moderate, or severe), demand attention. At our institute, we insist that all dysplastic lesions be treated surgically, since they all have the potential to undergo malignant transformation. In our opinion, it is imprudent to retain any pathological tissue, as malignant transformation is unpredictable. Patients treated with surgical removal should be warned that excision of the lesion does not guarantee freedom from lesion recurrence or from progression to cancer in the future. However, removal does lower the likelihood of these outcomes. We emphasize strict habit-cessation for our patients because in our experience, habit-cessation results in a reduced risk of malignant transformation compared to continuation of deleterious habits such as tobacco use and alcohol consumption (unpublished data). We would be obliged if the authors could shed light on some unanswered questions in their article [1], including: (1) How many patients who never smoked (n = 37) and who did smoke (n = 78) in the treated and untreated groups experienced malignant transformation? (2) Among the smokers, how many continued versus stopped smoking in the treated and untreated groups with regard to the ultimate outcome? (3) Among the treated patients, how many were treated surgically with blade or with laser, and what were their ultimate outcomes?
http://dx.doi.org/10.1016/j.oraloncology.2016.12.003 1368-8375/Ó 2016 Elsevier Ltd. All rights reserved.
(4) Was there was any difference between male and female patients with regard to malignant transformation in the treated and untreated groups? (5) Although they were not part of the study group, it would be interesting to know what happened to the other patients with mild or moderate dysplasia. The answers to these queries will benefit international readers in formulating a stringent protocol for the treatment of epithelial dysplasia, especially in developing countries like ours, where the major burden of dysplastic lesions are associated not only with smoked tobacco products but also with smokeless products (paan masala, areca nut, gutkha, etc.). Conflict of interest None declared. Reference [1] Zhang L, Lubpairee T, Laronde DM, Rosin MP. Should severe epithelial dysplasia be treated? Oral Oncol 2016;60(9):125–9.
Shivani Bansal ⇑ Rajiv S. Desai Pankaj M. Shirsat Pooja Prasad Department of Oral Pathology, Nair Hospital Dental College, A.L. Nair Road, Mumbai 400008, Maharashtra, India ⇑ Corresponding author. E-mail addresses: [email protected] (S. Bansal), [email protected] (R.S. Desai), [email protected] (P.M. Shirsat), [email protected] (P. Prasad) Available online xxxx
Contents lists available at ScienceDirect
Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology
Letter to the editor Epithelial dysplasia must be treated
Dear Sir, We read with great interest the article titled, ‘‘Should severe epithelial dysplasia be treated?” by Zhang et al. [1]. We appreciate the authors’ efforts to find an answer to this most difficult question in the field of oral oncology, and would like to share our views on this subject. While supporting Zhang et al.’s views on treating severe epithelial dysplastic lesions, we believe that all epithelial dysplastic lesions, irrespective of severity (i.e., mild, moderate, or severe), demand attention. At our institute, we insist that all dysplastic lesions be treated surgically, since they all have the potential to undergo malignant transformation. In our opinion, it is imprudent to retain any pathological tissue, as malignant transformation is unpredictable. Patients treated with surgical removal should be warned that excision of the lesion does not guarantee freedom from lesion recurrence or from progression to cancer in the future. However, removal does lower the likelihood of these outcomes. We emphasize strict habit-cessation for our patients because in our experience, habit-cessation results in a reduced risk of malignant transformation compared to continuation of deleterious habits such as tobacco use and alcohol consumption (unpublished data). We would be obliged if the authors could shed light on some unanswered questions in their article [1], including: (1) How many patients who never smoked (n = 37) and who did smoke (n = 78) in the treated and untreated groups experienced malignant transformation? (2) Among the smokers, how many continued versus stopped smoking in the treated and untreated groups with regard to the ultimate outcome? (3) Among the treated patients, how many were treated surgically with blade or with laser, and what were their ultimate outcomes?
http://dx.doi.org/10.1016/j.oraloncology.2016.12.003 1368-8375/Ó 2016 Elsevier Ltd. All rights reserved.
(4) Was there was any difference between male and female patients with regard to malignant transformation in the treated and untreated groups? (5) Although they were not part of the study group, it would be interesting to know what happened to the other patients with mild or moderate dysplasia. The answers to these queries will benefit international readers in formulating a stringent protocol for the treatment of epithelial dysplasia, especially in developing countries like ours, where the major burden of dysplastic lesions are associated not only with smoked tobacco products but also with smokeless products (paan masala, areca nut, gutkha, etc.). Conflict of interest None declared. Reference [1] Zhang L, Lubpairee T, Laronde DM, Rosin MP. Should severe epithelial dysplasia be treated? Oral Oncol 2016;60(9):125–9.
Shivani Bansal ⇑ Rajiv S. Desai Pankaj M. Shirsat Pooja Prasad Department of Oral Pathology, Nair Hospital Dental College, A.L. Nair Road, Mumbai 400008, Maharashtra, India ⇑ Corresponding author. E-mail addresses: [email protected] (S. Bansal), [email protected] (R.S. Desai), [email protected] (P.M. Shirsat), [email protected] (P. Prasad) Available online xxxx