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Plattenepithelkarzinom und potenziell maligne Veränderungen der Mundschleimhaut

Squamous cell carcinoma and potentially malignant disorders of the oral mucosa

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Zusammenfassung

Das Plattenepithelkarzinom ist der häufigste maligne Tumor der Mundschleimhaut. Diverse endogene und exogene Faktoren begünstigen seine Entstehung. Therapie und Prognose hängen wesentlich vom Tumorstadium ab. Die Früherkennung ist daher von entscheidender Bedeutung. In den meisten Fällen entwickelt sich das Karzinom aus einer „Leukoplakie“. Sowohl homogene Leukoplakien als auch inhomogene „Erythroleukoplakien“ sollen biopsiert werden. Die sog. „Bürstenbiopsie“, Auflichttechniken, molekularbiologische oder DNA-Untersuchungen sind derzeit noch nicht ausreichend verlässlich, oft technisch aufwendig und für die Praxis derzeit nicht geeignet. Bei großflächigen Präkanzerosen ist mit einer „field cancerisation“ zu rechnen. Weitere wichtige Präkanzerosen sind die proliferative verruköse Leukoplakie und der erosive Lichen planus. Das Management von oralen Präkanzerosen soll individuell gestaltet werden: Bei geringer Dysplasie kann zunächst abgewartet werden. Risikopatienten sollen ggf. in Intervallen biopsiert werden. Eine hochgradige Dysplasie („carcinoma in situ“) soll operativ entfernt werden.

Abstract

Squamous cell carcinoma is the most frequent malignant tumor of the oral mucosa. Various endogenous and exogenous factors promote its development. Therapy and prognosis depend mainly on tumor stage. Early detection is therefore of utmost importance. In most cases cancer develops from “leukoplakia”. Both homogeneous leukoplakias as well as “erythroleukoplakias” should be biopsied. The”brush-biopsy”, imaging techniques, molecular biologic or DNA tests are not reliable enough at present, often technically demanding and not applicable in daily practice. In extensive lesions “field cancerization” has to be considered. Further important precursor lesions are proliferative verrucous leukoplakia and erosive lichen planus. The management of oral precancerous lesions should be individually tailored: Low-grade dysplasia can be observed. If indicated, patients at risk should be biopsied in intervals. High-grade dysplasia (“carcinoma in situ”) should be surgically removed.

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  1. Univ.-Klinik für Mund-, Kiefer- und Gesichtschirurgie, Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Österreich

    J. Beck-Mannagetta

  2. Universitätsinstitut für Pathologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich

    G. Hutarew

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  1. J. Beck-Mannagetta
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Correspondence to J. Beck-Mannagetta.

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Beck-Mannagetta, J., Hutarew, G. Plattenepithelkarzinom und potenziell maligne Veränderungen der Mundschleimhaut. Hautarzt 60, 859–865 (2009). https://doi.org/10.1007/s00105-009-1801-6

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