A hipermatilação aberrante de regiões gênicas promotoras foi recentemente sugerida como meio de detecção do carcinoma epidermóide de cabeça e pescoço. Neste estudo nós avaliamos o status de metilação de um painel de 7 genes já relatados na literatura e sua correlação com lesões orais malignas e cancerizáveis de boca. Inicialmente, nós utilizamos amostras de enxágues salivares de pacientes com lesões benignas, displásicas e malignas para determinar a hipermetilação em regiões gênicas promotoras em pacientes de alto risco. Uma avaliação clínica de risco foi realizada e correlacionada com o diagnóstico histológico e status dos biomarcadores. A partir dos resultados analisados nas lesões intraorais, o gene DCC, que obteve a melhor performance entre os 7 genes, foi testado em lesões de queilite actínica e carcinoma epidermoide de lábio. Foram realizadas reações de PCR específica para metilação, quantitativa (Q-MSP) para os 7 genes (CCNA1, MGMT, MINT31, TIMP3, P16, DAPK, DCC) em enxágues salivares de 191 pacientes com lesões intraorais, e do gene DCC em 39 lesões de lábio. Análises de regressão logística e curva ROC foram utilizadas para avaliar a associação do status de metilação com o diagnóstico histológico e para estimar a acurácia da classificação respectivamente, nas amostras de enxágue salivar. Na análise multivariada, o diagnóstico displasia/ câncer foi associado com a idade (OR=1.3, 95% CI= (1.01-1.6, p=0.014) e a metilação do painel de 7 genes (OR=2.2, 95% CI=(1.34.0), p=0.006); a metilação do DCC também foi fortemente associada (OR=3.3, 95% CI=(1.7-6.6), p=0.004). Na análise multivariada, o diagnóstico histológico foi independentemente associado com a metilação do painel de 7 genes (OR=2.0, 95% CI=(1.1-3.6), p=0.027) ou do DCC (OR=2.8, 95% CI=(1.4-5.7), p=0.004). Uma nova análise, excluindo pacientes com diagnóstico prévio de câncer (n=30), e levando em conta uma classificação clínica de risco, foi realizada. Na análise univariada, DCC (OR=2.6, 95% CI=(1.1-6.1), p=0.026) e a classificação clínica de risco (OR=2.5, 95% CI=(1.3-5.1), p=0.008) foram associados com o diagnóstico de displasia/ câncer, e permaneceram significante na análise multivariada (DCC: OR=2.5, 95% CI= (1.1- 6.0), p=0.037, classificação de risco: OR=2.5, 95% CI=(1.2-5.0), p=0.012). A classificação clínica de risco identificou displasia/ câncer com a sensibilidade de (95% CI=4171%) e especificidade de 66% (95% CI= 5775%). A sensibilidade da classificação clínica de risco combinada com a metilação do painel de 7 genes melhorou, chegando a 71% (95% CI=5683%) e com a metilação do DCC chegou a 69% (95% CI=5481%). O status de metilação do painel de 7 genes, como também o DCC como um marcador individual, foi independentemente associado com o diagnóstico histológico em enxágues salivares. Nas lesões labiais não foi possível observar a mesma correlação entre o status de metilação do gene DCC e o diagnóstico histológico, provavelmente, devido a diferente etiologia das lesões intraorais e labiais. Os resultados mostram a potencial habilidade destes biomarcadores em prever o risco de presença de lesões intraorais cancerizáveis, usando uma abordagem não invasiva, além do potencial de melhorar a eficiência da classificação clínica de risco. Mas reforça a diferente etiologia das lesões intraorais e labiais e a necessidade de diferentes marcadores para essas lesões. / Aberrant promoter hypermethylation has been recently proposed as a means for detection of HNSCC in salivary rinses. Here we evaluate the ability of a previously reported 7-gene methylation panel status to correlate with premalignant and malignant oral lesions. We used a large prospective cohort of salivary rinses obtained from patients with benign, dysplastic, and cancer diagnoses to determine promoter hypermethylation in high-risk patients. Clinical risk assessment was performed and correlated with histological diagnosis and biomarker status. Also, a cohort of lip lesions was selected and methylation status of DCC gene was correlated with histology. Quantitative methylation-specific PCR (Q-MSP) was performed analyzing methylation status of 7 genes (CCNA1, MGMT, MINT31, TIMP3, P16, DAPK, DCC) in salivary rinses of 191 patients with oral lesion and 39 lip lesions. Logistic regression and receiver operating characteristic (ROC) analyses were used to examine the association of methylation status with histologic diagnosis and to estimate classification accuracy, respectively. On univariate analysis, diagnosis of dysplasia/cancer was associated with age (OR=1.3, 95% CI= (1.01-1.6, p=0.014) and 7-gene panel methylation (OR=2.2, 95% CI=(1.34.0), p=0.006); DCC methylation was also strongly associated (OR=3.3, 95% CI=(1.7-6.6), p=0.004). On multivariable modeling, histologic diagnosis was independently associated with 7 gene panel (OR=2.0, 95% CI=(1.1-3.6), p=0.027) or DCC (OR=2.8, 95% CI=(1.4- 5.7), p=0.004) methylation. A subset analyzed (n=161) without prior biopsy proven malignancy received clinical risk classification based on lesion examination. On univariate analysis, DCC (OR=2.6, 95% CI=(1.1-6.1), p=0.026) and clinical risk classification (OR=2.5, 95% CI=(1.3-5.1), p=0.008) were associated with diagnosis of dysplasia/cancer, and remained significant on multivariate analysis (DCC: OR=2.5, 95% CI= (1.1-6.0), p=0.037, risk classification: OR=2.5, 95% CI=(1.2-5.0), p=0.012). Clinical risk classification identified dysplasia/cancer with a sensitivity of 56% (95% CI=4171%) and specificity of 66% (95% CI= 5775%). The sensitivity of clinical risk classification combined with 7-gene panel methylation improved to 71% (95% CI=56 83%) and with DCC methylation improved to 69% (95% CI=5481%). The 7-gene panel methylation, as well DCC as a single marker, was independently associated with histologic diagnosis in salivary rinses. No correlation was found between DCC methylation status and histologic diagnosis of lip lesions, probably due different etiology of oral and lip lesions. The results show the potential ability of these biomarkers to predict risk for presence of oral premalignancy and malignancy using a non-invasive approach using salivary rinse and can improve the efficiency of clinical risk classification. Also, reinforces the different etiologic origins of intraoral and lip lesions and the need of different markers for these lesions.

O Carcinoma espinocelular (CEC) é o mais comum das neoplasias malignas da cavidade oral. Corresponde a cerca de 70 a 90% dos cânceres orais. Há aproximadamente 200.000 novos casos por ano no mundo. No Brasil são estimados cerca de 14.120 novos casos de câncer oral por ano. A literatura atual tem demonstrado uma alteração do perfil clínico do paciente portador de CEC em relação às quatro décadas passadas. Avaliamos os dados clínicos disponíveis de 665 pacientes diagnosticados com CEC da cavidade oral atendidos na Disciplina de Estomatologia Clínica da Faculdade de Odontologia da Universidade de São Paulo entre os anos de 1970 a 2009. As variáveis estudadas foram: idade, gênero, etnia e sitio primário do tumor. Os dados foram analisados estatisticamente entre as décadas. Os dados gerais encontrados revelaram que dos 665 casos analisados, 512 (76,99%) eram homens e 143 (21,50%) mulheres, sendo 538 (80,9%) leucodermas, 98 (14,74%) melanodermas, 15 (2,26%) feodermas e 14 (2,11%) xantodermas.Os sítios mais acometidos foram, o assoalho bucal com 150 (22,56%) casos, seguido pela língua com 142 (21,35%), mandíbula 88 (13,23%), palato 72 (10,83%), lábios 62 (9,32%), rebordo e fundo de sulco 31 (4,66%), outros (trígono retromolar, , mucosa jugal e tonsilas) com 94 (14,14%) e 26 (3,91%) sem dados. A idade média geral encontrada foi de 56,81 anos, sendo que nos homens foi de 55,88 anos e nas mulheres de 60,07 anos. Quanto ao gênero, na década de 70, os homens representavam 86% dos casos e na última década 74%, passando de uma relação de 5,93 H/M para 3,32 H/M, resultando em uma redução de 44% na relação homem / mulher. Quando se compara a idade entre as quatro décadas, observamos um aumento das idades médias, de 55,1 anos na primeira década para 60,07 anos na quarta década, porém sem relevância estatística. Pacientes leucodermas foram os mais acometidos na primeira década com 87,56% dos casos e na última com 76,55%, enquanto os melanodermas responderam por 6,47% dos casos na década de 70 e por 19,91% na última década. Não foi possível encontrar alterações significativas do perfil clínico dos pacientes com CEC entre as décadas analisadas. / Squamous cell carcinoma (SCC) is the most common malignancy of the oral cavity, accounting for up to 90% of oral cancers and, in Brazil, there are approximately 14,120 new cases of oral cancer per year. Current literature has shown a change in the clinical profile of patients with SCC in relation to the past four decades. We evaluated the clinical data of 665 patients diagnosed with SCC of the oral cavity treated at the Department of Stomatology Clinic, School of Dentistry, University of São Paulo between 1970 and 2009. The variables studied were age, gender, ethnicity, and primary tumor site. Data were statistically analyzed between the decades. The data revealed that out of 665 cases, 512 (76.99%) were men and 143 (21.50%) women. In the 70\'s, men accounted for 86% of cases and 74% in the last decade, with a ratio of 5.93 Male / Female to 3.32 M / F, a 44% reduction in the male to female ratio. In this cohort, 538 (80.9%) were Caucasian, 98 (14.74%) were Melanoderm, 15 (2.26%) were Mulatto, and 14 (2.11%) were Asian. Caucasian patients were the most affected in the first decade with 87.56% of cases and the last with 76.55%, while the black patients accounted for 6.47% of cases in the 70s and 19.91% in the last decade. The most common affected site was the floor of the mouth (150; 22.56%), followed by tongue (142; 21.35%), mandible (88; 13.23%), palate (72; 10.83%), lips (62; 9.32%), alveolar ridge and fornix (31; 4.66%), or other, e.g., retromolar trigone, buccal mucosa and tonsils (94; 14.14%). Twenty-six (3.91%) cases had no data. The mean age was 56.71, 55.88 years for men and 60.07 years for women. When comparing the age of four decades, an increase of the mean ages of 55.1 years in the first decade to 60.07 years in the fourth decade, but without statistical significance. In conclusion, this study did not find significant changes in the clinical profile of patients with SCC over time.

Magister Scientiae Dentium - MSc(Dent) / Background: Oral cancer is a major global healthcare problem. Its prevalence is increasing, and late-stage presentation is common. More than 500,000 patients are estimated to have oral cancer worldwide. Oral cavity squamous cell carcinoma (SCC) accounts for 90-94% of oral cancers. Survival rates for oral cancer are very poor, at around 50% and has not improved considerably in the previous decades even with advances in therapeutic interventions. Screening programs have been introduced for a number of major cancers and have demonstrated a compelling effect in their early detection. It’s now well established that the early detection of the malignancies is a competent way of improving the clinical outcome for patients. It’s believed that to reduce death and morbidity from this disease it is important to detect it at an early stage, when lesions are localized. Aim: To assess the level of awareness and knowledge of oral cancer among dental patients visiting Khartoum dental teaching Hospital. Method: A cross- sectional survey using a self-administered questionnaire with 18 questions was distributed to 193 patients between 18 and 65 years to collect the information. Results: The results indicate that there were more females (107; 55%) than males (86; 45%). There was a non-significant difference between alcohol consumption and awareness of oral cancer. However, the frequency results revealed that the majority of participants (98; 92 %), who reported they has heard about oral cancer, were females, while almost a quarter of participants (18; 21%) who had never heard about it, were males. This suggested that female patients were more aware of oral cancer than males. Participants, who declared hearing about oral cancer were more highly qualified educationally, whereas a quarter of them who declared they had never heard about it, were poorly qualified educationally.

A presença de áreas displásicas em queilites actínicas constitui um fator preditivo importante para o câncer de lábio. Entretanto, a determinação histopatológica da presença e intensidade da displasia epitelial nestas lesões continua sendo um aspecto subjetivo para os patologistas. O objetivo do presente estudo foi verificar em 45 queilites actínicas e 20 carcinomas espinocelulares (CECs) de lábio tratados no Departamento de Otorrinolaringologia e Oftalmologia, da Faculdade de Medicina de Botucatu, UNESP, a expressão imuno-histoquímica da citoqueratina 10 (CK10) e citoqueratina 13 (CK13) na região labial e comparar a expressão dessas citoqueratinas com o índice de proliferação celular determinado pela imunomarcação com o Ki-67. A intensidade da displasia epitelial nas queilites actínicas foi determinada em coloração de Hematoxilina e Eosina com base nos critérios definidos pela Organização Mundial da Saúde. A associação entre a expressão da CK10 e da CK13 nas queilites actínicas com e sem displasia e nos CECs foi calculada pelo teste do qui-quadrado ou teste exato de Fisher, com nível de significância de 5%. Os resultados demonstraram uma positividade para CK13 no vermelhão do lábio e mucosa labial, com perda de expressão nas áreas displásicas das queilites actínicas e marcação heterogênea nos CECs de lábio. A imunomarcação da CK10 foi observada no vermelhão do lábio e epiderme, com ausência total de expressão nas áreas displásicas e nos CECs de lábio. Houve uma associação estatisticamente significante entre a expressão da CK10 nos CECs quando comparada às queilites actínicas com displasia epitelial (p<0,001) e sem displasia epitelial (p<0,001). Não houve diferença significativa (p=0,104) no índice de proliferação celular, determinado pela imunomarcação do Ki-67, nas queilites actínicas sem e com displasia epitelial e nos carcinomas espinocelulares de lábio. Assim como também não houve associação, estatisticamente significativa, entre a expressão das citoqueratinas 13 e 10 e os altos índices de proliferação celular, determinados pelo Ki-67, nas queilites actínicas sem e com displasia epitelial. Esses resultados sugerem que as citoqueratinas 13 e 10 participam do processo de malignização das queilites actínicas sendo a expressão alterada ou ausente destes biomarcadores indicativa de áreas displásicas ou carcinoma espinocelular invasivo na região de lábio inferior. / The presence of dysplastic areas in actinic cheilitis is an important predictive factor for lip cancer. However, the histopathologic evaluation of the presence and severity of epithelial dysplasia in these lesions remains subjective. The aim of this study was to evaluate the immunohistochemical expression of cytokeratin 10 (CK10) and cytokeratin 13 (CK13) in labial region and compare the expression of these cytokeratins with the cell proliferation index, which was determined by Ki-67 immunostaining. The sample was constituted by 45 cases of actinic cheilitis and 20 of squamous cell carcinomas (SCC) of the lip treated at the Department of Otorhinolaryngology and Ophthalmology of Botucatu School of Medicine, UNESP. The severity of epithelial dysplasia in actinic cheilitis was determined by hematoxylin and eosin staining based on World Health Organization criteria. The association between the expression of CK10 and CK13 in actinic cheilitis with and without dysplasia and SCC was calculated by Chi-square test or Fischer´s exact test, with significance level at 5%. The results showed positive correlation for CK13 in the lip vermilion and labial mucosa, with loss of expression in the dysplastic areas of actinic cheilitis, and heterogeneous positivity in SCC of the lip. There was a statistically significant association between the expression of CK10 in SCC and actinic cheilitis with epithelial dysplasia (p < 0.001) or without epithelial dysplasia (p < 0.001).There was not a statistically significant difference (p=0.104) for cell proliferation index in actinic cheilitis with and without dysplasia, and SCC. Furthermore, there was not a statistical association (p>0.05) between the expression of CK10 and CK13 and high cell proliferation index in actinic cheilitis with and without epithelial dysplasia. These results suggest that the cytokeratins 13 and 10 participate in the process of malignant transformation of actinic cheilitis, and absence or alteration of these biomarkers expression are indicative of dysplastic areas or invasive squamous cell carcinoma in the lower lip region.

A hipermatilação aberrante de regiões gênicas promotoras foi recentemente sugerida como meio de detecção do carcinoma epidermóide de cabeça e pescoço. Neste estudo nós avaliamos o status de metilação de um painel de 7 genes já relatados na literatura e sua correlação com lesões orais malignas e cancerizáveis de boca. Inicialmente, nós utilizamos amostras de enxágues salivares de pacientes com lesões benignas, displásicas e malignas para determinar a hipermetilação em regiões gênicas promotoras em pacientes de alto risco. Uma avaliação clínica de risco foi realizada e correlacionada com o diagnóstico histológico e status dos biomarcadores. A partir dos resultados analisados nas lesões intraorais, o gene DCC, que obteve a melhor performance entre os 7 genes, foi testado em lesões de queilite actínica e carcinoma epidermoide de lábio. Foram realizadas reações de PCR específica para metilação, quantitativa (Q-MSP) para os 7 genes (CCNA1, MGMT, MINT31, TIMP3, P16, DAPK, DCC) em enxágues salivares de 191 pacientes com lesões intraorais, e do gene DCC em 39 lesões de lábio. Análises de regressão logística e curva ROC foram utilizadas para avaliar a associação do status de metilação com o diagnóstico histológico e para estimar a acurácia da classificação respectivamente, nas amostras de enxágue salivar. Na análise multivariada, o diagnóstico displasia/ câncer foi associado com a idade (OR=1.3, 95% CI= (1.01-1.6, p=0.014) e a metilação do painel de 7 genes (OR=2.2, 95% CI=(1.34.0), p=0.006); a metilação do DCC também foi fortemente associada (OR=3.3, 95% CI=(1.7-6.6), p=0.004). Na análise multivariada, o diagnóstico histológico foi independentemente associado com a metilação do painel de 7 genes (OR=2.0, 95% CI=(1.1-3.6), p=0.027) ou do DCC (OR=2.8, 95% CI=(1.4-5.7), p=0.004). Uma nova análise, excluindo pacientes com diagnóstico prévio de câncer (n=30), e levando em conta uma classificação clínica de risco, foi realizada. Na análise univariada, DCC (OR=2.6, 95% CI=(1.1-6.1), p=0.026) e a classificação clínica de risco (OR=2.5, 95% CI=(1.3-5.1), p=0.008) foram associados com o diagnóstico de displasia/ câncer, e permaneceram significante na análise multivariada (DCC: OR=2.5, 95% CI= (1.1- 6.0), p=0.037, classificação de risco: OR=2.5, 95% CI=(1.2-5.0), p=0.012). A classificação clínica de risco identificou displasia/ câncer com a sensibilidade de (95% CI=4171%) e especificidade de 66% (95% CI= 5775%). A sensibilidade da classificação clínica de risco combinada com a metilação do painel de 7 genes melhorou, chegando a 71% (95% CI=5683%) e com a metilação do DCC chegou a 69% (95% CI=5481%). O status de metilação do painel de 7 genes, como também o DCC como um marcador individual, foi independentemente associado com o diagnóstico histológico em enxágues salivares. Nas lesões labiais não foi possível observar a mesma correlação entre o status de metilação do gene DCC e o diagnóstico histológico, provavelmente, devido a diferente etiologia das lesões intraorais e labiais. Os resultados mostram a potencial habilidade destes biomarcadores em prever o risco de presença de lesões intraorais cancerizáveis, usando uma abordagem não invasiva, além do potencial de melhorar a eficiência da classificação clínica de risco. Mas reforça a diferente etiologia das lesões intraorais e labiais e a necessidade de diferentes marcadores para essas lesões. / Aberrant promoter hypermethylation has been recently proposed as a means for detection of HNSCC in salivary rinses. Here we evaluate the ability of a previously reported 7-gene methylation panel status to correlate with premalignant and malignant oral lesions. We used a large prospective cohort of salivary rinses obtained from patients with benign, dysplastic, and cancer diagnoses to determine promoter hypermethylation in high-risk patients. Clinical risk assessment was performed and correlated with histological diagnosis and biomarker status. Also, a cohort of lip lesions was selected and methylation status of DCC gene was correlated with histology. Quantitative methylation-specific PCR (Q-MSP) was performed analyzing methylation status of 7 genes (CCNA1, MGMT, MINT31, TIMP3, P16, DAPK, DCC) in salivary rinses of 191 patients with oral lesion and 39 lip lesions. Logistic regression and receiver operating characteristic (ROC) analyses were used to examine the association of methylation status with histologic diagnosis and to estimate classification accuracy, respectively. On univariate analysis, diagnosis of dysplasia/cancer was associated with age (OR=1.3, 95% CI= (1.01-1.6, p=0.014) and 7-gene panel methylation (OR=2.2, 95% CI=(1.34.0), p=0.006); DCC methylation was also strongly associated (OR=3.3, 95% CI=(1.7-6.6), p=0.004). On multivariable modeling, histologic diagnosis was independently associated with 7 gene panel (OR=2.0, 95% CI=(1.1-3.6), p=0.027) or DCC (OR=2.8, 95% CI=(1.4- 5.7), p=0.004) methylation. A subset analyzed (n=161) without prior biopsy proven malignancy received clinical risk classification based on lesion examination. On univariate analysis, DCC (OR=2.6, 95% CI=(1.1-6.1), p=0.026) and clinical risk classification (OR=2.5, 95% CI=(1.3-5.1), p=0.008) were associated with diagnosis of dysplasia/cancer, and remained significant on multivariate analysis (DCC: OR=2.5, 95% CI= (1.1-6.0), p=0.037, risk classification: OR=2.5, 95% CI=(1.2-5.0), p=0.012). Clinical risk classification identified dysplasia/cancer with a sensitivity of 56% (95% CI=4171%) and specificity of 66% (95% CI= 5775%). The sensitivity of clinical risk classification combined with 7-gene panel methylation improved to 71% (95% CI=56 83%) and with DCC methylation improved to 69% (95% CI=5481%). The 7-gene panel methylation, as well DCC as a single marker, was independently associated with histologic diagnosis in salivary rinses. No correlation was found between DCC methylation status and histologic diagnosis of lip lesions, probably due different etiology of oral and lip lesions. The results show the potential ability of these biomarkers to predict risk for presence of oral premalignancy and malignancy using a non-invasive approach using salivary rinse and can improve the efficiency of clinical risk classification. Also, reinforces the different etiologic origins of intraoral and lip lesions and the need of different markers for these lesions.

A presença de áreas displásicas em queilites actínicas constitui um fator preditivo importante para o câncer de lábio. Entretanto, a determinação histopatológica da presença e intensidade da displasia epitelial nestas lesões continua sendo um aspecto subjetivo para os patologistas. O objetivo do presente estudo foi verificar em 45 queilites actínicas e 20 carcinomas espinocelulares (CECs) de lábio tratados no Departamento de Otorrinolaringologia e Oftalmologia, da Faculdade de Medicina de Botucatu, UNESP, a expressão imuno-histoquímica da citoqueratina 10 (CK10) e citoqueratina 13 (CK13) na região labial e comparar a expressão dessas citoqueratinas com o índice de proliferação celular determinado pela imunomarcação com o Ki-67. A intensidade da displasia epitelial nas queilites actínicas foi determinada em coloração de Hematoxilina e Eosina com base nos critérios definidos pela Organização Mundial da Saúde. A associação entre a expressão da CK10 e da CK13 nas queilites actínicas com e sem displasia e nos CECs foi calculada pelo teste do qui-quadrado ou teste exato de Fisher, com nível de significância de 5%. Os resultados demonstraram uma positividade para CK13 no vermelhão do lábio e mucosa labial, com perda de expressão nas áreas displásicas das queilites actínicas e marcação heterogênea nos CECs de lábio. A imunomarcação da CK10 foi observada no vermelhão do lábio e epiderme, com ausência total de expressão nas áreas displásicas e nos CECs de lábio. Houve uma associação estatisticamente significante entre a expressão da CK10 nos CECs quando comparada às queilites actínicas com displasia epitelial (p<0,001) e sem displasia epitelial (p<0,001). Não houve diferença significativa (p=0,104) no índice de proliferação celular, determinado pela imunomarcação do Ki-67, nas queilites actínicas sem e com displasia epitelial e nos carcinomas espinocelulares de lábio. Assim como também não houve associação, estatisticamente significativa, entre a expressão das citoqueratinas 13 e 10 e os altos índices de proliferação celular, determinados pelo Ki-67, nas queilites actínicas sem e com displasia epitelial. Esses resultados sugerem que as citoqueratinas 13 e 10 participam do processo de malignização das queilites actínicas sendo a expressão alterada ou ausente destes biomarcadores indicativa de áreas displásicas ou carcinoma espinocelular invasivo na região de lábio inferior. / The presence of dysplastic areas in actinic cheilitis is an important predictive factor for lip cancer. However, the histopathologic evaluation of the presence and severity of epithelial dysplasia in these lesions remains subjective. The aim of this study was to evaluate the immunohistochemical expression of cytokeratin 10 (CK10) and cytokeratin 13 (CK13) in labial region and compare the expression of these cytokeratins with the cell proliferation index, which was determined by Ki-67 immunostaining. The sample was constituted by 45 cases of actinic cheilitis and 20 of squamous cell carcinomas (SCC) of the lip treated at the Department of Otorhinolaryngology and Ophthalmology of Botucatu School of Medicine, UNESP. The severity of epithelial dysplasia in actinic cheilitis was determined by hematoxylin and eosin staining based on World Health Organization criteria. The association between the expression of CK10 and CK13 in actinic cheilitis with and without dysplasia and SCC was calculated by Chi-square test or Fischer´s exact test, with significance level at 5%. The results showed positive correlation for CK13 in the lip vermilion and labial mucosa, with loss of expression in the dysplastic areas of actinic cheilitis, and heterogeneous positivity in SCC of the lip. There was a statistically significant association between the expression of CK10 in SCC and actinic cheilitis with epithelial dysplasia (p < 0.001) or without epithelial dysplasia (p < 0.001).There was not a statistically significant difference (p=0.104) for cell proliferation index in actinic cheilitis with and without dysplasia, and SCC. Furthermore, there was not a statistical association (p>0.05) between the expression of CK10 and CK13 and high cell proliferation index in actinic cheilitis with and without epithelial dysplasia. These results suggest that the cytokeratins 13 and 10 participate in the process of malignant transformation of actinic cheilitis, and absence or alteration of these biomarkers expression are indicative of dysplastic areas or invasive squamous cell carcinoma in the lower lip region.

Excerpt: According to the United States Centers for Disease Control and Prevention (CDC), approximately 20 million Americans are infected with human papillomavirus (HPV), and another 6 million will become infected each year.

There are many craniofacial anomalies that exist in the oral mucosa, gingiva, lips, tongue, maxilla, mandible, floor of the mouth, palate, and teeth. These anomalies cause secondary issues such as airway obstruction, respiratory problems, feeding problems, ear disease, distal systemic issues, and speech and communication problems. Children that experience craniofacial anomalies and subsequent problems are often at a disadvantage with medical and dental related consequences, and especially speech, communication, and often present with psychosocial concerns. This paper explores such anomalies, consequential problems, and emphasizes the importance of having a multidisciplinary team when treating patients with craniofacial anomalies. Multidisciplinary teams consist of otolaryngologists, plastic surgeons, general dentists, prosthodontists, orthodontists, oral surgeons, pediatricians, neurologists, geneticists, social workers, psychologists, audiologists, and speech therapists. Based on past studies and data, multidisciplinary treatment has shown not only to provide the best options to correct an anomaly, but also to optimize the overall health and well-being of an individual as well. Multidisciplinary treatment of craniofacial anomalies outlines a coherent, inclusive, and revolutionized way on how to holistically treat a patient. This approach is present in the healthcare realm, but often underrated and not adopted by all healthcare professionals; this paper will demonstrate how such an approach will advance healthcare. Surgery removes, corrects, or improves a condition that exists in the oral cavity or oropharynx. Nevertheless, surgery often causes subsequent conditions and may even not be successful. Among the many disciplines exercised in treating patients with craniofacial anomalies and conditions, this paper highlights the importance of speech and language pathologists, psychologists, dentists, orthodontists, and geneticists to be included in the treatment plan. Studies demonstrated that each discipline’s responsibility, when implemented in a coordinated and timely fashion, can improve the outcomes, possibly prevent ensuing conditions, and therefore, optimize an individual’s health and quality of life.

<p>Oral cancer is characterised by marked geographical differences in frequency and site preference as reported by various studies. In South Africa, a few studies have been reported on the patterns and aetiology of oral cancer, and age standardised incidence rates (ASIR). Studies in several countries have shown an increase in oral cancer incidence among younger people. Title:&nbsp / Epidemiology of oral cancer in South Africa 1996-2002.&nbsp / Aim and Objective: The aim of this study was to determine the age standardised incidence rates (ASIR) of oral cancer by age, gender, race&nbsp / and site in South Africa for a consecutive period of seven years. Method: Pathology case records of oral cancer diagnosed over a seven-year period from 1996 to 2002 and reported to the National&nbsp / Cancer Registry (NCR) were analysed for age, sex, race, and date of diagnosis, basis of diagnosis, topography and tumour type. The data was tabulated and categorised using Microsoft Excel. The South African population size for each year of the study was estimated by linear extrapolation using the 1996 and 2001 census results. Age standardisation incidence rates against the world&nbsp / population were calculated by the standard direct method. Results: The total number of oral squamous cell carcinoma cases over the 7-year period was 9702. The majority of cases (34%) were&nbsp / on the tongue. The male to female ratio was 1:3. The age standardized incidence rates in this study was lower among African women / (0.640 per 100000 per year) and the highest was 13.40 new cases per 100000 per year (coloured males). Lip cancer was highest among both males and females of the white population. The cumulative rate of developing oral cancer was 1:83 and 1:32 for males and females respectively.</p>

<p>Background and Aims: While a single &ldquo / high quality&rdquo / oral liquid based cytology (LBC) study has shown a high sensitivity and specificity for the technique in detection of oral dysplasia and malignancy, the high unit cost of this technology cannot be borne by the developing African countries. This study aims to evaluate the efficiency of an alternative cost-effective technique, Shandon PapSpin (PS) LBC in&nbsp / diagnosis of oral and oropharyngeal dysplasia and malignancy. Materials and Methods.We compared the diagnostic accuracy of Shandon PS LBC with that of scalpel biopsy in 69 patients. Transepithelial cytology specimens were obtained using a cervical Cytobrush. The cytology specimens were graded and scored using a novel oral cytologic grading and scoring system respectively. Results: Histological diagnosis of dysplasia or invasive squamous cell carcinoma was made in 51 of the 69 cases. Histology confirmed the cytological diagnosis of dysplasia or malignancy in 49 of the 51 cases. There were two false negative and no false positive cases. The sensitivity was 96% and the specificity 100%. The cytologic grade correlated positively with histologic grade. The best cut off value for distinguishing reactive/mildly dysplastic lesions from high 9 grade/invasive squamous cell carcinoma was determined as a cytologic score of 3, representing a sensitivity of 95% and a specificity of 96%. Conclusion: The Shandon PS LBC in association with transepithelial brush biopsy technique (TBBT) is a highly sensitive, specific and economical screening test in detection of oral and oropharyngeal dysplasia and malignancy. The proposed oral cytologic grading system correlates well with histology. The novel oral cytologic scoring system shows promise as a simple, reliable and reproducible scoring system. In addition, the liquid residual allows for immunocytochemical (Podoplanin) testing.</p>