Well-armed is well started: A population-based study to assess risk stratification in potentially premalignant oral epithelial lesions

BACKGROUND: The association between potentially premalignant oral epithelial lesions (PPOEL), oral squamous cell carcinoma and its higher incidence in South-East Asian population due to the use of arecanut, pan, slaked lime and tobacco is well known. The study was carried out in urban and rural population of Bengaluru, Karnataka, to assess and correlate the pattern of habit, clinical presentation and cytological grading of PPOELs, attempting at identifying the main arms associated with risk of malignant transformation. AIMS: Assessment of history, clinical presentation of PPOELs, co-relate with cytological grades and escalate to binary risk assessment. MATERIALS AND METHODS: One hundred and fourteen cytological smears received at the Department from screening camps were stained with Papanicolaou and hematoxylin-eosin stains and correlated with the clinical data. RESULTS/STATISTICS: Descriptive and inferential statistics were performed. 38% lie between 21 and 30 years, 76.3% males, 81 cases involved buccal mucosa with 51.1% Grade II cytosmear, 53.5% chewing tobacco habit, 10 cases involved multiple sites with 60% Grade II cytosmear and 6 cases showed Grade III cytosmear. Based on clinical risk factors and cytological grading, 15.3% were grouped under high risk lesions as against 5.4% when only cytological grading was considered. CONCLUSION: The incidence of PPOELs is increasing in young males with chewing tobacco mainly in buccal mucosa associated with habit. Biopsy and definitive treatment is necessary when the lesions are red, nonhomogeneous, seen in multiple sites and concomitant lesions with higher grades of dysplasia. The use of cytosmears in screening camps helps to assess, affirm and stress on biopsy on higher dysplasia grades as biopsy is not an acceptable norm in camps.