It’s Everywhere! State of the Art in Oral Field Cancerization

Tuesday, October 3, 2023

4:45 PM - 5:45 PM East Coast USA Time

Location: 201AB

Moderator(s)

CM

Caitlin P. McMullen, MD

Associate Member
Moffitt Cancer Center
Tampa, FL, United States

Panelist(s)

Steven B. Chinn, MD

Assistant Professor of Otolaryngology-Head and Neck Surgery
University of Michigan
Ann Arbor, MI, United States
AA

Ameya Asarkar, MD

Ochsner LSU Health, USA
FN

Farzad Nourollah-Zadeh, DMD

Assistant Professor, Department of Stomatology
Medical University of South Carolina, USA

Disclosure(s):

Caitlin P. McMullen, MD: No relevant relationships to disclose.

PROGRAM DESCRIPTION: Diffuse mucosal premalignant changes and multifocal squamous cell carcinoma present unique clinical challenges for the otolaryngologist and can be distressing to patients. In this program, conditions that predispose patients to diffuse malignant/premalignant changes and the management of those conditions will be reviewed. This panel will present practical, stepwise approaches to diffuse premalignant lesions and multifocal malignancy, including novel strategies and a discussion of challenging cases.

Oral lichen planus (OLP) and Proliferative Verrucous Leukoplakia (PVL) are an inflammatory conditions that can predispose wide areas of the oral mucosa to malignant transformation. The possible etiologies, differential diagnoses, the spectrum of presenting findings, clinical course, management strategies and emerging therapeutics will be reviewed. In addition to OLP and PVL, other causative and potentially modifiable factors will be discussed, including the role of dental products/materials.

The natural evolution of these conditions may result in multifocal disease. When broad areas of the oral mucosa demonstrate high grade premalignant changes or multifocal transformation, the role of surgery may be limited. A practical approach to multifocal or diffuse mucosal premalignant and malignant changes will be presented. The indications and outcomes of wide local excision and laser ablation as surgical management tools will be reviewed. The panelists will discuss when it may be appropriate to refer the patient for consideration of radiation and/or systemic therapy.

OUTCOME OBJECTIVE 1: Understand the etiologies of diffuse mucosal malignant and premalignant changes, including oral lichen planus, proliferative verrucous leukoplakia, and the role of dental products

OUTCOME OBJECTIVE 2: Apply medical and surgical therapies to minimize the risk of transformation and address multifocal high grade premalignant and malignant lesions

OUTCOME OBJECTIVE 3: Recognize when to refer the patient for radiation or systemic therapy

BACKGROUND STATEMENT: Field cancerization and diffuse premalignant changes in the oral mucosa present unique challenges for the otolaryngologist. A practical approach to these patients and knowledge of emerging strategies can optimize outcomes.