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Program Number: B195
Session Name: Poster Session

A model for a dedicated Oral Dysplasia clinic and insights about early cancer detection

Alexandra T Bourdillon, MD¹; Connie Zhou, BS²; Jane Lee, PhD¹; Hasan Abdulbaki²; Kamal Al-Eryani, DDS, PhD³; Eliah Shamir, MD, PhD⁴; Aaron Tward, MD, PhD¹; Matthew Spitzer, PhD¹; Patrick Ha, MD¹; ¹University of California - San Francisco, Department of Otolaryngology - Head & Neck Surgery; ²University of California, School of Medicine; ³University of California, Division of Oral Medicine, Oral Pathology, and Oral Radiology, School of Dentistry; ⁴Genentech, Inc.

Oral mucosal lesions such as oral epithelial dysplasia (OED), a precursor to oral cavity cancer, are common but challenging to manage or surveil. Limited guidance exists because it is difficult to prognosticate rates of OED recurrence and malignant transformation which do not necessarily conform to dysplasia severity alone. Our institution has one of the longest standing oral dysplasia clinics in partnership with the Department of Oral Medicine within the School of Dentistry. We conducted a study to evaluate longitudinal characteristics across an expansive time frame. Electronic and archived pathology reports from August 1994 to September 2023 were queried for cases of OED or other benign oral mucosal lesions. Subsequent pathologies detecting oral carcinomas were also included. Altogether, we captured 2,485 specimens across 1,395 distinct adults, as depicted in Table 1. The median age was 59 (range: 18-95). By subsite, the greatest proportion were from the oral tongue (1187, 47.8%), followed by alveolar gingiva (545, 21.9%) and then buccal mucosa (321, 12.9%), among others. Most individuals had only one sample (943, 67.6%), followed by two samples (270, 19.4%). Individuals with multiple biopsies were more likely to progress to carcinoma (Figure 1). By pathologic evaluation, a minority of cases (n=334, 13.4%) comprised non-dysplastic lesions such as hyperkeratosis (123), mucositis (36), verruciform lesions (28). Among the 1,925 dysplasia cases, most were mild (1,165, 60.5%), followed by moderate (325, 16.9%), and finally severe (234,12.2%). Two hundred thirty two carcinomas were captured with all except 9 verrucous carcinomas being squamous cell carcinomas (SCCs). Four individuals developed carcinoma in situ (n=4/94, 4.3%), while 105 individuals progressed to invasive SCC. Of these progressors, 94 tumors had reportable T classifications, with the overwhelming majority were T1 tumors (72/94, 76.6%), followed by T2 and T4 (10/94 or 10.6%, each), with 11 unreported T stages.  This study highlights patterns of presentation in one of the largest longitudinal OED cohorts. The preponderance of early-stage malignancies suggests that a robust oral dysplasia clinic is successful in identifying malignancies earlier and meaningfully improve outcomes.

Table 1: Cohort overview

Figure 1: Increased proportion of progressors with increased number of biopsies per patient

 

 

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