Screening and clinical examination of precancerous oral lesions:
- Screening:
Screening consists of detecting a lesion during a systematic examination carried out on all patients, but even more rigorously on patients over 50 or on patients at risk (obvious alcohol and smoking).
If an abnormality is detected during this complete examination of the oral mucosa, it should be the subject of an etiological investigation.
- Anamnesis: highlights
- Age and lifestyle
- Circumstances and conditions of appearance of lesions
- Medical history
- Circumstances and conditions of appearance of lesions
- Functional signs: pain, burning or stinging.
- A swelling
- A change in the color of the mucous membrane
- A discharge that may be serous, bloody or purulent.
- A functional disorder such as dysphagia, ageusia or even dysgeusia.
- The clinical examination:
- The inspection:
Extra-oral or facial inspection begins during the interrogation and must be done methodically.
The following are analyzed successively:
- Integuments: skin lesions, tumors, eruptions, scars
- The underlying deformations.
- From the front, the affected region is compared to the contralateral floor.
- From the side, the examination looks for asymmetry
- Palpation:
It mainly concerns the cervico-facial lymph nodes. Examination of the lesion: color, shape, consistency and its relationship with neighboring organs.
- Additional examinations:
- Biopsy:
This involves taking a sample of part of the lesion, with a view to confirming or refuting the clinical diagnosis, or providing additional details.
Choose an area representative of the entire lesion, preferably straddling the lesion and peripheral mucosa
Avoid inflammatory ulcers and areas of necrosis
For diffuse and multiple lesions, taking multiple samples is preferred to taking a larger sample.
Classically, two types of incisions are presented: triangular or elliptical.
The triangular incision limits the quality of the sutures at the end of the procedure.
The elliptical incision called an “orange quarter” has a major axis in length (10 mm).
- Fixation: The sampled fragment is immersed in a bottle containing the fixative liquid bearing a label or the information sheet.
- Bouin’s fluid is usually used for oral biopsies.
- 10% formalin is mainly used for large excisions.
- 10 to 20 times the sample volume.
- Immunohistochemistry:
IHC is a method of detecting antigens using antibodies. It is used for the diagnosis and/or monitoring of cancers by detecting abnormal cancerous cells.
- Vital dyes:
The solutions are applied locally.
They interact with tissue damage in various ways.
A more intense or particular coloration of the lesion is observed.
Nile blue, Cresyl blue or neutral red allow non-toxic coloring in order to study them alive under a light microscope.
- The toluidine blue test:
A basic vital dye that binds to nucleic acids, which explains its affinity for: neoplastic lesions But also inflammatory and traumatic lesions.
- A simple mouthwash, the pathological areas will retain the dye, it allows to specify the dimensions and the limits of the suspect area.
- It is only the first localizing phase of a biopsy or cytological sample.
- Exfoliative cytology:
This involves taking samples from a lesion (epithelial cells) by forceful scraping using:
- From a wooden or metal foam spatula
- By a cotton roll
- Or by a curette.
The sample is then carefully spread on a slide, then dried and protected before being sent to the laboratory .
- Indication: candidiasis, and does not find an indication in precancerous lesions , the sample will only bring back normal-looking cells or the cancer may remain silent on the smear.
- Brush sampling:
It responds to the same criticisms: too many false negatives and no architectural analysis of the tissues.
- Tumor biomarkers P53 phosphoprotein:
Overexpression of P53 has been reported in 11 to 80% of cases of head and neck cancers.
- Immunofluorescence :
Looking for specific Ac.
- Photographic report:
Allows you to appreciate the evolution.
Screening and clinical examination of oral precancerous lesions
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