2020 Volume 32 Issue 4 Pages 195-206
High-grade dysplasia and carcinoma without muscle invasion are temporarily defined as oral superficial carcinoma of the tongue. It is sometimes difficult to distinguish such lesions from many kinds of inflammatory and reactive lesions; the iodine staining method is a useful aid for the detection. Imaging devices, such as the narrow-band imaging endoscope, VELscopeⓇ and IllumiScanⓇ have been developed as adjunctive tools. VELscopeⓇ and IllumiScanⓇ show high sensitivity but low specificity. The excised mucosal margin should be free of high-grade dysplasia. Regarding the width of the deep margin, definitive criteria have not been established. The surgical wound is treated by primary closure, skin graft, or coverage with artificial materials. All these methods have both advantages and disadvantages. The surgical margin is evaluated intraoperatively by immediate histopathological examination. A novel technique using gamma glutamyltranspeptidase as a fluorescent tracer is a promising approach in this field. While the degree of epithelial dysplasia has been categorized into three grades, a binary system is advocated by the WHO. However, the criteria set by the WHO, the Japanese Society of Oral Tumor, and the Japanese Society of Head and Neck Cancer appear to have some differences. When histopathological DOI measurement is attempted based on the established horizon by AJCC, the measured values are sometimes negative under the condition in which dysplastic mucosa, “a not intact mucosa,” is widely distributed adjacent to the invasive carcinoma. It is necessary to revise these unsuitable and criterial differences, and to establish better common rules for oral surgeons, head and neck surgeons and pathologists.
