Clinical management of oral potentially malignant disorders: State of the art review and proposal for a new framework

Oral cancer remains a major health issue worldwide. Oral Potentially Malignant Disorders (OPMDs) constitute a wide range of lesions and conditions found in the oral cavity with a known risk of developing into oral squamous cell carcinoma. Common OPMDs include leukoplakia, erythroplakia, oral submucous fibrosis, oral lichen planus, and proliferative verrucous leukoplakia. Timely, well-targeted biopsy, coupled with risk-adapted follow-up and multidisciplinary care is essential to reduce malignant progression and achieve optimal patient outcomes. To address the absence of a unified weighting scheme for clinical and pathological predictors of malignant transformation in OPMDs, we conducted a targeted expert survey within the COST action INTERCEPTOR Working Group 2 (clinician-researchers with formal expertise in OPMDs). History of previous head and neck cancer, OPMD type, multifocality of the lesion clinical appearance and lifestyle habits received the highest weights in the survey on clinical prognostic factors. Future research priorities include development and validation of predictive models integrating clinical, histological, and molecular variables.