A decade of dysplasia: clinicopathological patterns and malignant transformation with Candida co-infection

Oral epithelial dysplasia (OED) is a key precursor to oral squamous cell carcinoma (OSCC); however, predicting its malignant transformation remains a clinical challenge due to its multifactorial aetiology and regional variations in risk-related habits. This study aimed to analyse the clinicopathological characteristics and malignant transformation potential of OED, including Candida-associated lesions, over a 10-year institutional period.

A 10-year retrospective analysis (2014-2025) was conducted on 305 histopathologically confirmed OED cases from the Department of Oral Pathology, Saveetha Dental College, Chennai. Demographic characteristics, lesion site, habits, dysplasia grade, oral submucous fibrosis (OSMF) stage, Candida colonisation, treatment modality, and progression to OSCC were recorded and analysed using SPSS v26.

Middle-aged males predominated (87%), with the buccal mucosa being the most common site (52%). Pan chewing without tobacco was the leading habit (31%). OSMF was present in 41% of patients, most of whom had advanced-stage disease, and moderate dysplasia accounted for 43% of cases. Candida colonisation was identified in 2.3% of cases, with no statistically significant association with transformation (p > 0.05). Among the 58 patients with documented follow-up, 15 (25.9%) demonstrated progression to OSCC during the available 12-month follow-up period. Malignant transformation occurred in 15 patients (4.9% of the total cohort) during follow-up. Surgical excision was the most frequent management approach, although long-term follow-up adherence remained low (19%).

OED in this South-Indian cohort exhibited a distinct aetiological profile dominated by pan chewing and OSMF; however the limited duration of follow-up precluded reliable estimation of the long-term malignant transformation rate. Candida infection appeared to be a minor co-factor rather than a direct predictor of progression.