Evaluation of Potentially Malignant Disorders in the Oral Cavity

Publication Date: October 1, 2017

Recommendations

The panel suggests that clinicians* should obtain an updated medical, social, and dental history and perform an intraoral and extraoral conventional visual and tactile examination† in all adult patients. (, )
(Good practice statement)
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The panel suggests that for adult patients with a clinically evident oral mucosal lesion with an unknown clinical diagnosis considered to be seemingly innocuous or nonsuspicious of malignancy, or other symptoms, clinicians should follow up periodically with the patient to determine the need for further evaluation. If the lesion has not resolved and the clinical diagnosis of a PMD cannot be ruled out, then clinicians should perform a biopsy of the lesion or refer the patient to a specialist.§ (C, L)
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The panel suggests that for adult patients with a clinically evident oral mucosal lesion considered to be suspicious of a PMD or malignant disorder, or other symptoms, clinicians should perform a biopsy of the lesion or provide immediate referral to a specialist. (CL)
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The panel does not recommend cytologic adjuncts for the evaluation of PMDs among adult patients with clinically evident, seemingly innocuous, or suspicious lesions. Should a patient decline the clinician's recommendation for performing a biopsy of the lesion or referral to a specialist, the clinician can use a cytologic adjunct to provide additional lesion assessment. (CL)
A positive or atypical cytologic test result reinforces the need for a biopsy or referral. A negative cytologic test result indicates the need for periodic follow-up of the patient. If the clinician detects persistence or progression of the lesion, immediately performing a biopsy of the lesion or referral to a specialist is indicated.
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The panel does not recommend autofluorescence, tissue reflectance, or vital staining adjuncts for the evaluation of PMDs among adult patients with clinically evident, seemingly innocuous, or suspicious lesions. (C, )
(low-quality evidence to very low-quality evidence)
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The panel suggests that for adult patients with no clinically evident lesions or symptoms, no further action is necessary at that time. (CL)
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The panel does not recommend commercially available salivary adjuncts for the evaluation of PMDs among adult patients with or without clinically evident, seemingly innocuous, or suspicious lesions, and their use should be considered only in the context of research. (CL)
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A positive or atypical cytologic test result reinforces the need for a biopsy or referral. A negative cytologic test result indicates the need for periodic follow-up of the patient. If the clinician detects persistence or progression of the lesion, immediately performing a biopsy of the lesion or referral to a specialist is indicated. (, )
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∗ Clinician refers to the target audience for this guideline, but only those trained to perform a biopsies (that is, dentists) should do so.
† Examination refers to initial, routine, or emergency visits.
§ Specialist refers to clinicians with advanced training in oral and maxillofacial surgery, oral and maxillofacial pathology, oral medicine, periodontology, and otolaryngology–head and neck surgery.

Recommendation Grading

Disclaimer

Overview

Title

Evaluation of Potentially Malignant Disorders in the Oral Cavity

Authoring Organizations

Publication Month/Year

October 1, 2017

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations to inform primary care clinicians about the potential use of adjuncts as triage tools for the evaluation of lesions, including potentially malignant disorders (PMDs), in the oral cavity.

Target Patient Population

Patients with oral lesions

Inclusion Criteria

Male, Female, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Laboratory services, Outpatient

Intended Users

Dentist, nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Assessment and screening

Diseases/Conditions (MeSH)

D002294 - Carcinoma, Squamous Cell, D018307 - Neoplasms, Squamous Cell, D003945 - Diagnosis, Oral, D009909 - Oral Health, D019242 - Oral Medicine

Keywords

squamous cell carcinoma, oral cavity, cancer screening, oncology, oral cancer, potentially malignant disorders