MANAGEMENT OF POTENTIALLY MALIGNANT DISORDERS

Abstract

Oral potentially malignant disorders (OPDs) comprise a heterogeneous set of lesions and conditions of the oral mucosa associated with a higher risk of transformation into oral squamous cell carcinoma (OSCC). Among the most frequent OPDs are oral leukoplakia, oral lichen planus, and oral submucosal fibrosis, whose rates of malignancy vary according to etiological factors, histopathological characteristics, and influences of the tissue microenvironment. The pathogenesis of these lesions involves complex interactions between cellular stressors, including chronic mechanical stress, alterations in the oral microbiota, and changes in the extracellular matrix, factors that contribute to genomic instability and the progression of carcinogenesis. The progression to malignancy is favored by a tumor microenvironment characterized by hypoxia, production of inflammatory cytokines, and the presence of cancer-associated fibroblasts, elements that promote unregulated cell proliferation and immune evasion mechanisms. Traditionally, the clinical management of malignant malignant disorders (MMDs) has been based on periodic surveillance and surgical excision of lesions; however, recurrence rates and associated morbidity have stimulated the development of more conservative and targeted therapeutic approaches. In this context, photodynamic therapy (PDT) has emerged as a promising alternative, using photosensitizers such as Toluidine Blue and Chlorine-e6, capable of promoting tissue selectivity and good clinical response rates. In parallel, advances in understanding the oral microbiota have enabled the introduction of probiotics and prebiotics as adjuvant strategies in inflammatory modulation and control of the lesional microenvironment. Furthermore, recent studies investigate molecular targets related to extracellular matrix stiffness and mechanotransduction pathways, as well as drugs with metabolic effects, such as metformin, which may interfere with pre-malignant progression. Therefore, contemporary management of oral malignant disorders (OMDDs) tends to integrate early diagnosis, minimally invasive therapies, and approaches based on microenvironmental biology, aiming to reduce the risk of progression to invasive oral carcinoma.