Outcomes of surgical management of dysplastic oral mucosal lesions versus observation: A systematic analysis

Abstract

Background: The aim was to investigate the outcomes of surgical management versus observation of dysplastic oral mucosal lesions. Method: Twenty-one papers met the a priori inclusion criteria, resulting in a total of 1943 lesions in 1599 patients. Epithelial dysplasia was grouped as “low-grade” and “high-grade”. Clinical outcome was established as the proportion of lesions with complete response, partial response, no response, malignant transformation, and recurrence/new lesions. Data on surgical intervention versus no treatment/observation was statistically analyzed. Results: Surgical management was provided in 80% of all lesions, versus observation in 20%. Following removal of lesions reported in studies without dysplasia, low grade dysplasia was reported in 59.9% of the oral potentially malignant disorders (OPMDs), and high-grade dysplasia in 40.1% of lesions. In the analysis, overall malignant outcome was 4.99%, and was similar in both the observation and surgical management groups (p = 0.554). The overall successful outcome (complete and partial responses) for all treatment was 45.31%, persistence or recurrences were observed in 27.99% of all OPMDs. In low grade lesions, there was no correlation between the complete or partial responses (p = 0.446), and the number of malignant transformation and recurrences/new lesions (p = 0.310). Similarly, in high grade lesions, no correlation was observed between the complete or partial responses (p = 0.140), and the number of malignant transformation and recurrences/new lesions (p = 0.673). Further analyses revealed no differences between the outcomes of surgical treatment and observation in low risk group (p = 0.358) and in high risk group (p = 0.258). Conclusion: This analysis shows that OPMDs treated by either surgical removal or observation alone have similar risks of malignant transformation irrespective of the degree of dysplasia, indicating the need for active surveillance of all dysplastic OPMDs. *Correspondence to: Pelin Güneri, Department of Oral and Maxillofacial Radiology, School of Dentistry, Ege University, Bornova, İzmir, Turkey, Tel: +902323881081; Fax: +902323880325; E-mail: peleen_2000@yahoo.com