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To treat ... or not to treat? Clinicians' views on the management of oral potentially malignant disorders

Lookup NU author(s): Professor Peter Thomson

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Abstract

Oral potentially malignant disorders (PMD) are recognisable mucosal conditions that have a variable and unpredictable risk of transformation to invasive squamous cell carcinoma (SCC). Modern management relies initially on clinical recognition of suspicious lesions and histopathological assessment and grading after incisional biopsy. However, it then varies from wide excision to observation and review, and depends not only on the severity of dysplasia but also on the clinician's preference as there is no high-level evidence to support best practice. We invited clinicians from oral and maxillofacial surgery, oral medicine, ear, nose, and throat (ENT), and plastic surgery, to complete an online questionnaire on current practice, which included 3 fictitious cases, to ascertain their views on the management of PMD and to find out whether they would be interested in becoming involved in a proposed future randomised controlled trial (RCT). Of the 251 who replied, 178 (71%) were oral and maxillofacial surgeons, and 99 (39%) expressed an interest in participating in a future RCT. Most respondents (n = 164 or 99%) would always treat severely dysplastic lesions by excision or laser ablation, whereas only 8% (n = 13) would always excise mild dysplasia. The greatest equipoise among those interested in taking part in a RCT was found in the case of moderate dysplasia for which 27% (n = 27) favoured observation compared with surgical excision or laser ablation. This study shows that there is support for a multicentre, prospective RCT that compares observation with resection and laser ablation in patients with moderate dysplasia. (C) 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Publication metadata

Author(s): Thomson PJ, McCaul JA, Ridout F, Hutchison IL

Publication type: Article

Publication status: Published

Journal: British Journal of Oral and Maxillofacial Surgery

Year: 2015

Volume: 53

Issue: 10

Pages: 1027-1031

Print publication date: 01/12/2015

Online publication date: 23/10/2015

Acceptance date: 24/08/2015

ISSN (print): 0266-4356

ISSN (electronic): 1532-1940

Publisher: Churchill Livingstone

URL: http://dx.doi.org/10.1016/j.bjoms.2015.08.263

DOI: 10.1016/j.bjoms.2015.08.263

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