Dysplasia Predicts Transformation — MFDS Part 1 MCQ

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ModerateOral PathologyDysplasia Predicts TransformationMFDS Part 1

A 58-year-old patient has a persistent non-homogeneous leukoplakic lesion on the lateral border of the tongue. Incisional biopsy shows no invasive carcinoma. Which histopathological finding provides the most established routine indication of the lesion's risk of future malignant transformation?

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Correct answer: B — Presence and grade of epithelial dysplasia

The correct answer is B. In an oral potentially malignant disorder, the presence and histological grade of epithelial dysplasia provide the most established routinely available indication of malignant transformation risk. Higher-grade dysplasia is associated with greater risk than mild dysplasia. Prediction remains imperfect: some non-dysplastic lesions transform, while many dysplastic lesions do not, so clinical features and continued specialist surveillance also matter. Hyperkeratosis and acanthosis are common reactive or architectural changes but do not independently provide equivalent prognostic information. Chronic inflammation is non-specific. Candidal hyphae may represent secondary colonisation and do not constitute the principal routine predictor of malignant transformation.

Reference: Turton N, Payne K, Higginson J, et al. Prognostic biomarkers for malignant progression of oral epithelial dysplasia: an updated systematic review and meta-analysis. British Journal of Oral and Maxillofacial Surgery. 2024;62(5):415-425. https://pubmed.ncbi.nlm.nih.gov/38677951/