<\/strong><\/span><\/h4>\n<\/strong><\/span><\/h4>\nConf. Univ. Dr. Toader Paula<\/strong><\/span>
Universitatea de Medicin\u0103 \u015fi Farmacie \u201cGrigore T. Popa\u201d, Ia\u015fi, Rom\u00e2nia<\/strong><\/span><\/h4>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row disabled_on=”off|off|off” _builder_version=”4.20.2″ locked=”off” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.20.4″ hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n
Dermatomiozita paraneoplazic\u0103 – provoc\u0103ri diagnostice \u0219i op\u021biuni terapeutice<\/span><\/p>\n Autori: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Elena Porumb-Andrese2, Daciana Elena Branisteanu2<\/span>
1UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u0103
2 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103, Disciplina Dermatologie<\/p>\nDermatomiozita paraneoplazic\u0103 (DMPN) este o boal\u0103 autoimun\u0103 rar\u0103 care apar\u021bine grupului de miozite autoimune, ce se caracterizeaz\u0103 prin erup\u021bii cutanate \u0219i grade variabile de miopatie. Etiologia DM este \u00eenc\u0103 necunoscut\u0103, dar o varietate de factori, inclusiv predispozi\u021bia genetic\u0103, factori de mediu \u0219i mecanisme imune \u0219i non-imune, par s\u0103 joace un rol \u00een dezvoltarea sa. DM este adesea asociat\u0103 cu alte tulbur\u0103ri autoimune \u0219i se caracterizeaz\u0103 prin prezen\u021ba mai multor subseturi de autoanticorpi.
Una dintre caracteristicile cheie ale DM este dat\u0103 de prezen\u021ba miocitotoxicit\u0103\u021bii mediate de celulele T sau a microangiopatiei mediate de complement. \u021ainta principal\u0103 este, reprezentat\u0103 de endoteliul capilarelor endomiziale asupra c\u0103ruia ac\u021bioneaz\u0103 complexul de atac membranar, format din C5b-9 \u0219i fragmentele C3b, C3bNEO \u0219i C4b. Cu toate acestea, antigenele \u0219i factorii declan\u0219atori specifici care ini\u021biaz\u0103 patogeneza DM nu au fost \u00eenc\u0103 elucida\u021bi.
\u00cen diagnosticul DM, afectarea cutanat\u0103 joac\u0103 un rol important, fiind esen\u021bial\u0103 prezen\u021ba unei leziuni cutanate tipice. Manifest\u0103rile cutanate preced adesea cu luni sau ani implicarea muscular\u0103, la mai mult de 50% dintre pacien\u021bi. Riscul relativ de carcinom la pacien\u021bii cu DM variaz\u0103 \u00eentre 3% \u0219i 8%, iar un screening complet este recomandat, fiind indicat\u0103 scanarea CT a toracelui, abdomenului \u0219i pelvisului la to\u021bi pacien\u021bii cu DM nou diagnostica\u021bi. IgG anti-TIF1 (p155\/140) a fost recent asociat\u0103 cu DM paraneoplazic\u0103, iar o expresie antigenic\u0103 comun\u0103 \u00eentre celulele musculare regenerate \u0219i celulele canceroase a fost remarcat\u0103.
Medicamentele imunosupresoare reprezint\u0103 baza terapiei \u00een tratamentul DM. Cu toate acestea, din cauza lipsei de consens \u00een ceea ce prive\u0219te clasificarea bolii, studiilor clinice relevante \u0219i m\u0103surarea standardizat\u0103 a rezultatelor, nu s-a ajuns la un acord cu privire la tratament. Mai mul\u021bi factori, precum v\u00e2rsta, activitatea bolii \u0219i comorbidit\u0103\u021bile, ar trebui lua\u021bi \u00een considerare \u00een alegerea planului terapeutic. Corticosteroizii \u00een doze mari (1 mg\/kg\/zi) sunt considera\u021bi terapia de prim\u0103 linie, cu un agent imunosupresor de a doua linie recomandat \u00een cazurile de lips\u0103 de r\u0103spuns la tratament sau recidiv\u0103 \u00een timpul reducerii dozei. Medicamentele imunosupresoare de a doua linie includ azatioprina, metotrexatul, micofenolatul de mofetil, rituximabul \u0219i imunoglobulina administrat\u0103 intravenos. Excizia complet\u0103 a tumorii este recomandat\u0103 la toate cazurile \u00een care exist\u0103 aceast\u0103 posibilitate. O \u00eent\u00e2rziere \u00een \u00eenceperea terapiei se asociaz\u0103 cu un prognostic \u0219i o evolu\u021bie nefast\u0103.<\/p>\n
Paraneoplastic dermatomyositis- diagnostic challenges and therapeutic options<\/span><\/p>\nAuthors: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Elena Porumb-Andrese2, Daciana Elena Branisteanu2<\/span>
1UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u0103
2 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103, Disciplina Dermatologie<\/p>\nParaneoplastic dermatomyositis (PNDM) is a rare autoimmune disease that belongs to the group of autoimmune myositides. It is characterized by skin rashes and varying degrees of myopathy. The exact cause of DM is still unknown, but a variety of factors, including genetic predisposition, environmental triggers, and immune- and non-immune-mediated mechanisms, are believed to play a role in its development. DM is often associated with other autoimmune disorders and is characterized by several subsets of autoantibodies.
One of the key features of DM is the presence of T-cell-mediated myocytotoxicity or complement-mediated microangiopathy. The endothelium of the endomysial capillaries is the primary target in DM, attacked by the membranolytic attack complex, which is formed by C3b, C3bNEO, and C4b fragments and C5b-9. However, the specific target antigens and triggers that initiate the pathogenesis of DM have not yet been identified.
To diagnose DM, a typical skin manifestation is required, as cutaneous features play a crucial role. Skin lesions often precede muscle involvement by months or years in over 50% of DM patients. The relative risk of carcinoma in DM patients ranges from 3% to 8%, and a broad cancer screening is recommended, with a chest, abdomen, and pelvic CT scan suggested for all newly diagnosed DM patients. Anti-TIF1 (p155\/140) IgG has been recently associated with paraneoplastic DM, and a shared antigen expression between regenerating muscle cells and cancer cells has been postulated.
Immunosuppressive drugs are the mainstay of therapy for DM. However, due to the lack of consensus on classification, relevant clinical trials, and standardized outcome measures, no consensus on therapy has been reached. Several factors, such as age, disease activity, and comorbidities, should be considered when planning a treatment regimen. High-dose corticosteroids (1 mg\/kg\/day) are the first-line therapy, with a second-line immunosuppressive agent recommended for cases of no improvement or relapse while tapering. Second-line immunosuppressive drugs include azathioprine, methotrexate, mycophenolate mofetil, rituximab, and intravenous immunoglobulin. Complete excision of the tumor should be performed whenever possible. A delay in starting therapy can result in a worse prognosis and outcome.<\/p>\n
Managementul leziunilor orale cu poten\u021bial de transformare malign\u0103<\/span><\/p>\n Autori: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Victor Vlad Costan2<\/span>
1UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u0103
2 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Chirurgie oro-maxilo-faciala<\/p>\nCancerul oral reprezint\u0103 3% din patologia malign\u0103 \u0219i este considerat o problem\u0103 semnificativ\u0103 de s\u0103n\u0103tate. Aproximativ 300.000 de cazuri noi au fost raportate \u00een 2020 la nivel mondial, 177,384 de decese fiind cauzate de aceast\u0103 patologie. Cu toate c\u0103 diagnosticul leziunilor maligne este relativ facil, examenul anatomo-patologic reprezent\u00e2nd \u00eenc\u0103 \u201c standardul de aur\u201d, supravie\u021buirea \u0219i calitatea vie\u021bii nu au prezentat nicio cre\u0219tere marcant\u0103 pe parcursul ultimelor decenii.
Majoritatea condi\u021biilor maligne se dezvolt\u0103 din leziuni premaligne ale cavit\u0103\u021bii orale. Cel mai frecvent \u00eent\u00e2lnite leziuni cu poten\u021bial de transformare malign\u0103 sunt leucoplazia, eritroplazia\/eritroleucoplazia, fibroza oral\u0103 submucoas\u0103, cheilita actinica cronic\u0103 \u0219i lichenul plan oral. Printre leziunile orale mai rar \u00eent\u00e2lnite se num\u0103r\u0103 leziunile de keratoz\u0103 tabagic\u0103, leukoedem, leukoderma, lupus eritematos discoid \u0219i epidermoliza buloas\u0103. Aproximativ 17% dintre aceste leziuni se vor transforma \u00eentr-o tumor\u0103 malign\u0103 pe o perioada de 7 ani de la diagnostic.
P\u00e2n\u0103 \u00een prezent nu exist\u0103 un consens universal \u00een ceea ce prive\u0219te tratamentul cel mai adecvat \u0219i durata sau intervalul de urm\u0103rire al leziunilor cu poten\u021bial de transformare malign\u0103, iar managementul lor este ghidat doar de examenul histopatologic.Tipul de terapie ales variaz\u0103 \u00een func\u021bie de factorii care depind riscul de malignitate al pacientului ( v\u00e2rst\u0103, sex, obiceiuri), precum \u0219i de factorii ce \u021bin de leziunea propriu-zis\u0103 (dimensiune, morfologie, rata de transformare malign\u0103, localizare).
\u00cen cazul unei displazie sau carcinom in situ, mai ales \u00een cazurile de displazie epitelial\u0103 moderat\u0103 sau sever\u0103, excizia conven\u021bional\u0103 cu margini clare este obligatorie. Alte op\u021biuni chirurgicale includ electrocoagularea, criochirurgia \u0219i chirurgia cu laser.Tratamentul conservator al leziunilor cu risc malign sc\u0103zut p\u00e2n\u0103 la moderat include utilizarea agen\u021bilor chimiopreventivi precum vitaminele (vitaminele A, C, E), fenretinida (analog al vitaminei A), carotenoidele (beta-caroten, licopenul),inhibitori\/ antagoni\u0219ti ai EGFR, inhibitori ai ciclooxigenazei 2, modulatori ai p53, bleomicina, inhibitorul de proteaz\u0103, medicamentele antiinflamatoare, ceaiul verde, curcuma etc. \u0219i este recomandat pentru leziunile orale care nu prezint\u0103 semne de displazie.
Depistarea \u0219i diagnosticarea precoce a leziunilor cu poten\u021bial de transformare malign\u0103, precum \u0219i urm\u0103rirea lor constant\u0103, reprezinta \u00een prezent cea mai bun\u0103 abordare terapeutic\u0103.<\/p>\n
Management of potentially malignant oral lesions<\/span><\/p>\nAuthors: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Victor Vlad Costan2<\/span>
1UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u0103
2 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Chirurgie oro-maxilo-faciala<\/p>\nOral cancer represents 3% of malignant pathology and is considered a significant health problem. Approximately 300,000 new cases were reported worldwide in 2020, with 177,384 deaths caused by this pathology. Although the diagnosis of malignant lesions is relatively easy, with anatomopathological examination still representing the “gold standard,” survival and quality of life have not shown any significant increase over the past few decades. Most malignant conditions develop from premalignant lesions of the oral cavity. The most commonly encountered potentially malignant oral lesions are leukoplakia, erythroplakia\/erythroleukoplakia, submucosal oral fibrosis, chronic actinic cheilitis, and oral lichen planus. Among the less commonly encountered oral lesions are tobacco keratosis lesions, leukoedema, leukoderma, discoid lupus erythematosus, and bullous epidermolysis. Approximately 17% of these lesions will transform into a malignant tumor within 7 years of diagnosis.
To date, there is no universal consensus regarding the most appropriate treatment and the duration or interval of follow-up for potentially malignant oral lesions, and their management is guided only by histopathological examination. The type of therapy chosen varies depending on patient risk factors for malignancy (age, sex, habits), as well as factors related to the lesion itself (size, morphology, malignant transformation rate, location).
In the case of dysplasia or carcinoma in situ, especially in cases of moderate to severe epithelial dysplasia, conventional excision with clear margins is mandatory. Other surgical options include electrocoagulation, cryosurgery, and laser surgery. Conservative treatment of low to moderate malignant risk lesions includes the use of chemopreventive agents such as vitamins (vitamins A, C, E), fenretinide (analog of vitamin A), carotenoids (beta-carotene, lycopene), EGFR inhibitors\/antagonists, COX-2 inhibitors, p53 modulators, bleomycin, protease inhibitor, anti-inflammatory drugs, green tea, turmeric, etc., and is recommended for oral lesions that do not show signs of dysplasia.Early detection and diagnosis of potentially malignant oral lesions, as well as constant monitoring, currently represent the best therapeutic approach.<\/p>\n
<\/p>\n
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Conf. Univ. Dr. Toader PaulaUniversitatea de Medicin\u0103 \u015fi Farmacie \u201cGrigore T. Popa\u201d, Ia\u015fi, Rom\u00e2niaDermatomiozita paraneoplazic\u0103 – provoc\u0103ri diagnostice \u0219i op\u021biuni terapeutice Autori: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Elena Porumb-Andrese2, Daciana Elena Branisteanu21UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u01032 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103, […]<\/p>\n","protected":false},"author":2,"featured_media":12415,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[12],"tags":[],"class_list":["post-12414","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lectori"],"_links":{"self":[{"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/posts\/12414","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/comments?post=12414"}],"version-history":[{"count":11,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/posts\/12414\/revisions"}],"predecessor-version":[{"id":13075,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/posts\/12414\/revisions\/13075"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/media\/12415"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/media?parent=12414"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/categories?post=12414"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/tags?post=12414"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Conf. Univ. Dr. Toader Paula<\/strong><\/span>
Universitatea de Medicin\u0103 \u015fi Farmacie \u201cGrigore T. Popa\u201d, Ia\u015fi, Rom\u00e2nia<\/strong><\/span><\/h4>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row disabled_on=”off|off|off” _builder_version=”4.20.2″ locked=”off” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.20.4″ hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n
Dermatomiozita paraneoplazic\u0103 – provoc\u0103ri diagnostice \u0219i op\u021biuni terapeutice<\/span><\/p>\n Autori: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Elena Porumb-Andrese2, Daciana Elena Branisteanu2<\/span>
1UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u0103
2 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103, Disciplina Dermatologie<\/p>\nDermatomiozita paraneoplazic\u0103 (DMPN) este o boal\u0103 autoimun\u0103 rar\u0103 care apar\u021bine grupului de miozite autoimune, ce se caracterizeaz\u0103 prin erup\u021bii cutanate \u0219i grade variabile de miopatie. Etiologia DM este \u00eenc\u0103 necunoscut\u0103, dar o varietate de factori, inclusiv predispozi\u021bia genetic\u0103, factori de mediu \u0219i mecanisme imune \u0219i non-imune, par s\u0103 joace un rol \u00een dezvoltarea sa. DM este adesea asociat\u0103 cu alte tulbur\u0103ri autoimune \u0219i se caracterizeaz\u0103 prin prezen\u021ba mai multor subseturi de autoanticorpi.
Una dintre caracteristicile cheie ale DM este dat\u0103 de prezen\u021ba miocitotoxicit\u0103\u021bii mediate de celulele T sau a microangiopatiei mediate de complement. \u021ainta principal\u0103 este, reprezentat\u0103 de endoteliul capilarelor endomiziale asupra c\u0103ruia ac\u021bioneaz\u0103 complexul de atac membranar, format din C5b-9 \u0219i fragmentele C3b, C3bNEO \u0219i C4b. Cu toate acestea, antigenele \u0219i factorii declan\u0219atori specifici care ini\u021biaz\u0103 patogeneza DM nu au fost \u00eenc\u0103 elucida\u021bi.
\u00cen diagnosticul DM, afectarea cutanat\u0103 joac\u0103 un rol important, fiind esen\u021bial\u0103 prezen\u021ba unei leziuni cutanate tipice. Manifest\u0103rile cutanate preced adesea cu luni sau ani implicarea muscular\u0103, la mai mult de 50% dintre pacien\u021bi. Riscul relativ de carcinom la pacien\u021bii cu DM variaz\u0103 \u00eentre 3% \u0219i 8%, iar un screening complet este recomandat, fiind indicat\u0103 scanarea CT a toracelui, abdomenului \u0219i pelvisului la to\u021bi pacien\u021bii cu DM nou diagnostica\u021bi. IgG anti-TIF1 (p155\/140) a fost recent asociat\u0103 cu DM paraneoplazic\u0103, iar o expresie antigenic\u0103 comun\u0103 \u00eentre celulele musculare regenerate \u0219i celulele canceroase a fost remarcat\u0103.
Medicamentele imunosupresoare reprezint\u0103 baza terapiei \u00een tratamentul DM. Cu toate acestea, din cauza lipsei de consens \u00een ceea ce prive\u0219te clasificarea bolii, studiilor clinice relevante \u0219i m\u0103surarea standardizat\u0103 a rezultatelor, nu s-a ajuns la un acord cu privire la tratament. Mai mul\u021bi factori, precum v\u00e2rsta, activitatea bolii \u0219i comorbidit\u0103\u021bile, ar trebui lua\u021bi \u00een considerare \u00een alegerea planului terapeutic. Corticosteroizii \u00een doze mari (1 mg\/kg\/zi) sunt considera\u021bi terapia de prim\u0103 linie, cu un agent imunosupresor de a doua linie recomandat \u00een cazurile de lips\u0103 de r\u0103spuns la tratament sau recidiv\u0103 \u00een timpul reducerii dozei. Medicamentele imunosupresoare de a doua linie includ azatioprina, metotrexatul, micofenolatul de mofetil, rituximabul \u0219i imunoglobulina administrat\u0103 intravenos. Excizia complet\u0103 a tumorii este recomandat\u0103 la toate cazurile \u00een care exist\u0103 aceast\u0103 posibilitate. O \u00eent\u00e2rziere \u00een \u00eenceperea terapiei se asociaz\u0103 cu un prognostic \u0219i o evolu\u021bie nefast\u0103.<\/p>\n
Paraneoplastic dermatomyositis- diagnostic challenges and therapeutic options<\/span><\/p>\nAuthors: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Elena Porumb-Andrese2, Daciana Elena Branisteanu2<\/span>
1UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u0103
2 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103, Disciplina Dermatologie<\/p>\nParaneoplastic dermatomyositis (PNDM) is a rare autoimmune disease that belongs to the group of autoimmune myositides. It is characterized by skin rashes and varying degrees of myopathy. The exact cause of DM is still unknown, but a variety of factors, including genetic predisposition, environmental triggers, and immune- and non-immune-mediated mechanisms, are believed to play a role in its development. DM is often associated with other autoimmune disorders and is characterized by several subsets of autoantibodies.
One of the key features of DM is the presence of T-cell-mediated myocytotoxicity or complement-mediated microangiopathy. The endothelium of the endomysial capillaries is the primary target in DM, attacked by the membranolytic attack complex, which is formed by C3b, C3bNEO, and C4b fragments and C5b-9. However, the specific target antigens and triggers that initiate the pathogenesis of DM have not yet been identified.
To diagnose DM, a typical skin manifestation is required, as cutaneous features play a crucial role. Skin lesions often precede muscle involvement by months or years in over 50% of DM patients. The relative risk of carcinoma in DM patients ranges from 3% to 8%, and a broad cancer screening is recommended, with a chest, abdomen, and pelvic CT scan suggested for all newly diagnosed DM patients. Anti-TIF1 (p155\/140) IgG has been recently associated with paraneoplastic DM, and a shared antigen expression between regenerating muscle cells and cancer cells has been postulated.
Immunosuppressive drugs are the mainstay of therapy for DM. However, due to the lack of consensus on classification, relevant clinical trials, and standardized outcome measures, no consensus on therapy has been reached. Several factors, such as age, disease activity, and comorbidities, should be considered when planning a treatment regimen. High-dose corticosteroids (1 mg\/kg\/day) are the first-line therapy, with a second-line immunosuppressive agent recommended for cases of no improvement or relapse while tapering. Second-line immunosuppressive drugs include azathioprine, methotrexate, mycophenolate mofetil, rituximab, and intravenous immunoglobulin. Complete excision of the tumor should be performed whenever possible. A delay in starting therapy can result in a worse prognosis and outcome.<\/p>\n
Managementul leziunilor orale cu poten\u021bial de transformare malign\u0103<\/span><\/p>\n Autori: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Victor Vlad Costan2<\/span>
1UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u0103
2 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Chirurgie oro-maxilo-faciala<\/p>\nCancerul oral reprezint\u0103 3% din patologia malign\u0103 \u0219i este considerat o problem\u0103 semnificativ\u0103 de s\u0103n\u0103tate. Aproximativ 300.000 de cazuri noi au fost raportate \u00een 2020 la nivel mondial, 177,384 de decese fiind cauzate de aceast\u0103 patologie. Cu toate c\u0103 diagnosticul leziunilor maligne este relativ facil, examenul anatomo-patologic reprezent\u00e2nd \u00eenc\u0103 \u201c standardul de aur\u201d, supravie\u021buirea \u0219i calitatea vie\u021bii nu au prezentat nicio cre\u0219tere marcant\u0103 pe parcursul ultimelor decenii.
Majoritatea condi\u021biilor maligne se dezvolt\u0103 din leziuni premaligne ale cavit\u0103\u021bii orale. Cel mai frecvent \u00eent\u00e2lnite leziuni cu poten\u021bial de transformare malign\u0103 sunt leucoplazia, eritroplazia\/eritroleucoplazia, fibroza oral\u0103 submucoas\u0103, cheilita actinica cronic\u0103 \u0219i lichenul plan oral. Printre leziunile orale mai rar \u00eent\u00e2lnite se num\u0103r\u0103 leziunile de keratoz\u0103 tabagic\u0103, leukoedem, leukoderma, lupus eritematos discoid \u0219i epidermoliza buloas\u0103. Aproximativ 17% dintre aceste leziuni se vor transforma \u00eentr-o tumor\u0103 malign\u0103 pe o perioada de 7 ani de la diagnostic.
P\u00e2n\u0103 \u00een prezent nu exist\u0103 un consens universal \u00een ceea ce prive\u0219te tratamentul cel mai adecvat \u0219i durata sau intervalul de urm\u0103rire al leziunilor cu poten\u021bial de transformare malign\u0103, iar managementul lor este ghidat doar de examenul histopatologic.Tipul de terapie ales variaz\u0103 \u00een func\u021bie de factorii care depind riscul de malignitate al pacientului ( v\u00e2rst\u0103, sex, obiceiuri), precum \u0219i de factorii ce \u021bin de leziunea propriu-zis\u0103 (dimensiune, morfologie, rata de transformare malign\u0103, localizare).
\u00cen cazul unei displazie sau carcinom in situ, mai ales \u00een cazurile de displazie epitelial\u0103 moderat\u0103 sau sever\u0103, excizia conven\u021bional\u0103 cu margini clare este obligatorie. Alte op\u021biuni chirurgicale includ electrocoagularea, criochirurgia \u0219i chirurgia cu laser.Tratamentul conservator al leziunilor cu risc malign sc\u0103zut p\u00e2n\u0103 la moderat include utilizarea agen\u021bilor chimiopreventivi precum vitaminele (vitaminele A, C, E), fenretinida (analog al vitaminei A), carotenoidele (beta-caroten, licopenul),inhibitori\/ antagoni\u0219ti ai EGFR, inhibitori ai ciclooxigenazei 2, modulatori ai p53, bleomicina, inhibitorul de proteaz\u0103, medicamentele antiinflamatoare, ceaiul verde, curcuma etc. \u0219i este recomandat pentru leziunile orale care nu prezint\u0103 semne de displazie.
Depistarea \u0219i diagnosticarea precoce a leziunilor cu poten\u021bial de transformare malign\u0103, precum \u0219i urm\u0103rirea lor constant\u0103, reprezinta \u00een prezent cea mai bun\u0103 abordare terapeutic\u0103.<\/p>\n
Management of potentially malignant oral lesions<\/span><\/p>\nAuthors: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Victor Vlad Costan2<\/span>
1UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u0103
2 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Chirurgie oro-maxilo-faciala<\/p>\nOral cancer represents 3% of malignant pathology and is considered a significant health problem. Approximately 300,000 new cases were reported worldwide in 2020, with 177,384 deaths caused by this pathology. Although the diagnosis of malignant lesions is relatively easy, with anatomopathological examination still representing the “gold standard,” survival and quality of life have not shown any significant increase over the past few decades. Most malignant conditions develop from premalignant lesions of the oral cavity. The most commonly encountered potentially malignant oral lesions are leukoplakia, erythroplakia\/erythroleukoplakia, submucosal oral fibrosis, chronic actinic cheilitis, and oral lichen planus. Among the less commonly encountered oral lesions are tobacco keratosis lesions, leukoedema, leukoderma, discoid lupus erythematosus, and bullous epidermolysis. Approximately 17% of these lesions will transform into a malignant tumor within 7 years of diagnosis.
To date, there is no universal consensus regarding the most appropriate treatment and the duration or interval of follow-up for potentially malignant oral lesions, and their management is guided only by histopathological examination. The type of therapy chosen varies depending on patient risk factors for malignancy (age, sex, habits), as well as factors related to the lesion itself (size, morphology, malignant transformation rate, location).
In the case of dysplasia or carcinoma in situ, especially in cases of moderate to severe epithelial dysplasia, conventional excision with clear margins is mandatory. Other surgical options include electrocoagulation, cryosurgery, and laser surgery. Conservative treatment of low to moderate malignant risk lesions includes the use of chemopreventive agents such as vitamins (vitamins A, C, E), fenretinide (analog of vitamin A), carotenoids (beta-carotene, lycopene), EGFR inhibitors\/antagonists, COX-2 inhibitors, p53 modulators, bleomycin, protease inhibitor, anti-inflammatory drugs, green tea, turmeric, etc., and is recommended for oral lesions that do not show signs of dysplasia.Early detection and diagnosis of potentially malignant oral lesions, as well as constant monitoring, currently represent the best therapeutic approach.<\/p>\n
<\/p>\n
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Conf. Univ. Dr. Toader PaulaUniversitatea de Medicin\u0103 \u015fi Farmacie \u201cGrigore T. Popa\u201d, Ia\u015fi, Rom\u00e2niaDermatomiozita paraneoplazic\u0103 – provoc\u0103ri diagnostice \u0219i op\u021biuni terapeutice Autori: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Elena Porumb-Andrese2, Daciana Elena Branisteanu21UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u01032 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103, […]<\/p>\n","protected":false},"author":2,"featured_media":12415,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[12],"tags":[],"class_list":["post-12414","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lectori"],"_links":{"self":[{"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/posts\/12414","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/comments?post=12414"}],"version-history":[{"count":11,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/posts\/12414\/revisions"}],"predecessor-version":[{"id":13075,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/posts\/12414\/revisions\/13075"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/media\/12415"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/media?parent=12414"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/categories?post=12414"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/tags?post=12414"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Autori: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Elena Porumb-Andrese2, Daciana Elena Branisteanu2<\/span> Dermatomiozita paraneoplazic\u0103 (DMPN) este o boal\u0103 autoimun\u0103 rar\u0103 care apar\u021bine grupului de miozite autoimune, ce se caracterizeaz\u0103 prin erup\u021bii cutanate \u0219i grade variabile de miopatie. Etiologia DM este \u00eenc\u0103 necunoscut\u0103, dar o varietate de factori, inclusiv predispozi\u021bia genetic\u0103, factori de mediu \u0219i mecanisme imune \u0219i non-imune, par s\u0103 joace un rol \u00een dezvoltarea sa. DM este adesea asociat\u0103 cu alte tulbur\u0103ri autoimune \u0219i se caracterizeaz\u0103 prin prezen\u021ba mai multor subseturi de autoanticorpi. Paraneoplastic dermatomyositis- diagnostic challenges and therapeutic options<\/span><\/p>\n Authors: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Elena Porumb-Andrese2, Daciana Elena Branisteanu2<\/span> Paraneoplastic dermatomyositis (PNDM) is a rare autoimmune disease that belongs to the group of autoimmune myositides. It is characterized by skin rashes and varying degrees of myopathy. The exact cause of DM is still unknown, but a variety of factors, including genetic predisposition, environmental triggers, and immune- and non-immune-mediated mechanisms, are believed to play a role in its development. DM is often associated with other autoimmune disorders and is characterized by several subsets of autoantibodies. Managementul leziunilor orale cu poten\u021bial de transformare malign\u0103<\/span><\/p>\n Autori: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Victor Vlad Costan2<\/span> Cancerul oral reprezint\u0103 3% din patologia malign\u0103 \u0219i este considerat o problem\u0103 semnificativ\u0103 de s\u0103n\u0103tate. Aproximativ 300.000 de cazuri noi au fost raportate \u00een 2020 la nivel mondial, 177,384 de decese fiind cauzate de aceast\u0103 patologie. Cu toate c\u0103 diagnosticul leziunilor maligne este relativ facil, examenul anatomo-patologic reprezent\u00e2nd \u00eenc\u0103 \u201c standardul de aur\u201d, supravie\u021buirea \u0219i calitatea vie\u021bii nu au prezentat nicio cre\u0219tere marcant\u0103 pe parcursul ultimelor decenii. Management of potentially malignant oral lesions<\/span><\/p>\n Authors: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Victor Vlad Costan2<\/span> Oral cancer represents 3% of malignant pathology and is considered a significant health problem. Approximately 300,000 new cases were reported worldwide in 2020, with 177,384 deaths caused by this pathology. Although the diagnosis of malignant lesions is relatively easy, with anatomopathological examination still representing the “gold standard,” survival and quality of life have not shown any significant increase over the past few decades. Most malignant conditions develop from premalignant lesions of the oral cavity. The most commonly encountered potentially malignant oral lesions are leukoplakia, erythroplakia\/erythroleukoplakia, submucosal oral fibrosis, chronic actinic cheilitis, and oral lichen planus. Among the less commonly encountered oral lesions are tobacco keratosis lesions, leukoedema, leukoderma, discoid lupus erythematosus, and bullous epidermolysis. 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Univ. Dr. Toader PaulaUniversitatea de Medicin\u0103 \u015fi Farmacie \u201cGrigore T. Popa\u201d, Ia\u015fi, Rom\u00e2niaDermatomiozita paraneoplazic\u0103 – provoc\u0103ri diagnostice \u0219i op\u021biuni terapeutice Autori: Mihaela Paula Toader1, Oana Mihaela Condurache Hritcu1, Elena Porumb-Andrese2, Daciana Elena Branisteanu21UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u01032 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103, […]<\/p>\n","protected":false},"author":2,"featured_media":12415,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[12],"tags":[],"class_list":["post-12414","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lectori"],"_links":{"self":[{"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/posts\/12414","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/comments?post=12414"}],"version-history":[{"count":11,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/posts\/12414\/revisions"}],"predecessor-version":[{"id":13075,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/posts\/12414\/revisions\/13075"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/media\/12415"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/media?parent=12414"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/categories?post=12414"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pdi.ro\/2023\/wp-json\/wp\/v2\/tags?post=12414"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
1UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u0103
2 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103, Disciplina Dermatologie<\/p>\n
Una dintre caracteristicile cheie ale DM este dat\u0103 de prezen\u021ba miocitotoxicit\u0103\u021bii mediate de celulele T sau a microangiopatiei mediate de complement. \u021ainta principal\u0103 este, reprezentat\u0103 de endoteliul capilarelor endomiziale asupra c\u0103ruia ac\u021bioneaz\u0103 complexul de atac membranar, format din C5b-9 \u0219i fragmentele C3b, C3bNEO \u0219i C4b. Cu toate acestea, antigenele \u0219i factorii declan\u0219atori specifici care ini\u021biaz\u0103 patogeneza DM nu au fost \u00eenc\u0103 elucida\u021bi.
\u00cen diagnosticul DM, afectarea cutanat\u0103 joac\u0103 un rol important, fiind esen\u021bial\u0103 prezen\u021ba unei leziuni cutanate tipice. Manifest\u0103rile cutanate preced adesea cu luni sau ani implicarea muscular\u0103, la mai mult de 50% dintre pacien\u021bi. Riscul relativ de carcinom la pacien\u021bii cu DM variaz\u0103 \u00eentre 3% \u0219i 8%, iar un screening complet este recomandat, fiind indicat\u0103 scanarea CT a toracelui, abdomenului \u0219i pelvisului la to\u021bi pacien\u021bii cu DM nou diagnostica\u021bi. IgG anti-TIF1 (p155\/140) a fost recent asociat\u0103 cu DM paraneoplazic\u0103, iar o expresie antigenic\u0103 comun\u0103 \u00eentre celulele musculare regenerate \u0219i celulele canceroase a fost remarcat\u0103.
Medicamentele imunosupresoare reprezint\u0103 baza terapiei \u00een tratamentul DM. Cu toate acestea, din cauza lipsei de consens \u00een ceea ce prive\u0219te clasificarea bolii, studiilor clinice relevante \u0219i m\u0103surarea standardizat\u0103 a rezultatelor, nu s-a ajuns la un acord cu privire la tratament. Mai mul\u021bi factori, precum v\u00e2rsta, activitatea bolii \u0219i comorbidit\u0103\u021bile, ar trebui lua\u021bi \u00een considerare \u00een alegerea planului terapeutic. Corticosteroizii \u00een doze mari (1 mg\/kg\/zi) sunt considera\u021bi terapia de prim\u0103 linie, cu un agent imunosupresor de a doua linie recomandat \u00een cazurile de lips\u0103 de r\u0103spuns la tratament sau recidiv\u0103 \u00een timpul reducerii dozei. Medicamentele imunosupresoare de a doua linie includ azatioprina, metotrexatul, micofenolatul de mofetil, rituximabul \u0219i imunoglobulina administrat\u0103 intravenos. Excizia complet\u0103 a tumorii este recomandat\u0103 la toate cazurile \u00een care exist\u0103 aceast\u0103 posibilitate. O \u00eent\u00e2rziere \u00een \u00eenceperea terapiei se asociaz\u0103 cu un prognostic \u0219i o evolu\u021bie nefast\u0103.<\/p>\n
1UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u0103
2 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103, Disciplina Dermatologie<\/p>\n
One of the key features of DM is the presence of T-cell-mediated myocytotoxicity or complement-mediated microangiopathy. The endothelium of the endomysial capillaries is the primary target in DM, attacked by the membranolytic attack complex, which is formed by C3b, C3bNEO, and C4b fragments and C5b-9. However, the specific target antigens and triggers that initiate the pathogenesis of DM have not yet been identified.
To diagnose DM, a typical skin manifestation is required, as cutaneous features play a crucial role. Skin lesions often precede muscle involvement by months or years in over 50% of DM patients. The relative risk of carcinoma in DM patients ranges from 3% to 8%, and a broad cancer screening is recommended, with a chest, abdomen, and pelvic CT scan suggested for all newly diagnosed DM patients. Anti-TIF1 (p155\/140) IgG has been recently associated with paraneoplastic DM, and a shared antigen expression between regenerating muscle cells and cancer cells has been postulated.
Immunosuppressive drugs are the mainstay of therapy for DM. However, due to the lack of consensus on classification, relevant clinical trials, and standardized outcome measures, no consensus on therapy has been reached. Several factors, such as age, disease activity, and comorbidities, should be considered when planning a treatment regimen. High-dose corticosteroids (1 mg\/kg\/day) are the first-line therapy, with a second-line immunosuppressive agent recommended for cases of no improvement or relapse while tapering. Second-line immunosuppressive drugs include azathioprine, methotrexate, mycophenolate mofetil, rituximab, and intravenous immunoglobulin. Complete excision of the tumor should be performed whenever possible. A delay in starting therapy can result in a worse prognosis and outcome.<\/p>\n
1UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u0103
2 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Chirurgie oro-maxilo-faciala<\/p>\n
Majoritatea condi\u021biilor maligne se dezvolt\u0103 din leziuni premaligne ale cavit\u0103\u021bii orale. Cel mai frecvent \u00eent\u00e2lnite leziuni cu poten\u021bial de transformare malign\u0103 sunt leucoplazia, eritroplazia\/eritroleucoplazia, fibroza oral\u0103 submucoas\u0103, cheilita actinica cronic\u0103 \u0219i lichenul plan oral. Printre leziunile orale mai rar \u00eent\u00e2lnite se num\u0103r\u0103 leziunile de keratoz\u0103 tabagic\u0103, leukoedem, leukoderma, lupus eritematos discoid \u0219i epidermoliza buloas\u0103. Aproximativ 17% dintre aceste leziuni se vor transforma \u00eentr-o tumor\u0103 malign\u0103 pe o perioada de 7 ani de la diagnostic.
P\u00e2n\u0103 \u00een prezent nu exist\u0103 un consens universal \u00een ceea ce prive\u0219te tratamentul cel mai adecvat \u0219i durata sau intervalul de urm\u0103rire al leziunilor cu poten\u021bial de transformare malign\u0103, iar managementul lor este ghidat doar de examenul histopatologic.Tipul de terapie ales variaz\u0103 \u00een func\u021bie de factorii care depind riscul de malignitate al pacientului ( v\u00e2rst\u0103, sex, obiceiuri), precum \u0219i de factorii ce \u021bin de leziunea propriu-zis\u0103 (dimensiune, morfologie, rata de transformare malign\u0103, localizare).
\u00cen cazul unei displazie sau carcinom in situ, mai ales \u00een cazurile de displazie epitelial\u0103 moderat\u0103 sau sever\u0103, excizia conven\u021bional\u0103 cu margini clare este obligatorie. Alte op\u021biuni chirurgicale includ electrocoagularea, criochirurgia \u0219i chirurgia cu laser.Tratamentul conservator al leziunilor cu risc malign sc\u0103zut p\u00e2n\u0103 la moderat include utilizarea agen\u021bilor chimiopreventivi precum vitaminele (vitaminele A, C, E), fenretinida (analog al vitaminei A), carotenoidele (beta-caroten, licopenul),inhibitori\/ antagoni\u0219ti ai EGFR, inhibitori ai ciclooxigenazei 2, modulatori ai p53, bleomicina, inhibitorul de proteaz\u0103, medicamentele antiinflamatoare, ceaiul verde, curcuma etc. \u0219i este recomandat pentru leziunile orale care nu prezint\u0103 semne de displazie.
Depistarea \u0219i diagnosticarea precoce a leziunilor cu poten\u021bial de transformare malign\u0103, precum \u0219i urm\u0103rirea lor constant\u0103, reprezinta \u00een prezent cea mai bun\u0103 abordare terapeutic\u0103.<\/p>\n
1UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Dermatologie Oral\u0103
2 UMF \u00abGrigore T. Popa \u00bb, Ia\u0219i, Facultatea de Medicin\u0103 Dentar\u0103, Disciplina Chirurgie oro-maxilo-faciala<\/p>\n
To date, there is no universal consensus regarding the most appropriate treatment and the duration or interval of follow-up for potentially malignant oral lesions, and their management is guided only by histopathological examination. The type of therapy chosen varies depending on patient risk factors for malignancy (age, sex, habits), as well as factors related to the lesion itself (size, morphology, malignant transformation rate, location).
In the case of dysplasia or carcinoma in situ, especially in cases of moderate to severe epithelial dysplasia, conventional excision with clear margins is mandatory. Other surgical options include electrocoagulation, cryosurgery, and laser surgery. Conservative treatment of low to moderate malignant risk lesions includes the use of chemopreventive agents such as vitamins (vitamins A, C, E), fenretinide (analog of vitamin A), carotenoids (beta-carotene, lycopene), EGFR inhibitors\/antagonists, COX-2 inhibitors, p53 modulators, bleomycin, protease inhibitor, anti-inflammatory drugs, green tea, turmeric, etc., and is recommended for oral lesions that do not show signs of dysplasia.Early detection and diagnosis of potentially malignant oral lesions, as well as constant monitoring, currently represent the best therapeutic approach.<\/p>\n<\/span><\/p>\n
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