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Oral epithelial dysplasia: Recognition, grading and clinical significance

Research output: Contribution to journalArticlepeer-review

Edward Odell, Omar Kujan, Saman Warnakulasuriya, Philip Sloan

Original languageEnglish
Pages (from-to)1947-1976
Number of pages30
JournalOral Diseases
Issue number8
Early online date14 Sep 2021
Accepted/In press2021
E-pub ahead of print14 Sep 2021
PublishedNov 2021

Bibliographical note

Funding Information: The authors participated in the Expert Symposium on Oral Potentially Malignant Disorders held by the WHO Collaborating Centre (UK) in March 2020. We thank the Royal College of Physicians and Surgeons (RCPSG) for providing logistic support for this symposium and Henry Schein Cares for an educational grant for travel expenses to some attendees. Since the topics covered in this paper were not agreed in detail at the symposium, this is not a consensus document and has no official WHO status. It reflects the views of the authors, though we thank Professors NW Johnson, JM Aguirre-Urizar, L Monteiro, G Ogden and other symposium members for their input and constructive criticism during and after the meeting. Publisher Copyright: © 2021 Wiley Periodicals LLC

King's Authors


Histopathological grading of epithelial dysplasia remains the principal laboratory method for assessing the risk of malignant transformation in oral potentially malignant disorders (OPMDs). Current views on the molecular pathogenesis and histological interpretation of the features of epithelial dysplasia are described, and the use of grading systems for epithelial dysplasia is discussed. Changes to the current 2017 WHO criteria for diagnosis are proposed with emphasis on the architectural features of epithelial dysplasia. The predictive values of three-grade and binary systems are summarised, and categories of epithelial dysplasia are reviewed, including lichenoid and verrucous lesions, keratosis of unknown significance, HPV-associated dysplasia, differentiated and basaloid epithelial dysplasia. The implications of finding epithelial dysplasia in an oral biopsy for clinical management are discussed from the pathologists' viewpoint.

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