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Medicina Oral, Patología Oral y Cirugía Bucal (Internet)

On-line version ISSN 1698-6946

Med. oral patol. oral cir.bucal (Internet) vol.11 n.2  Mar./Apr. 2006




Dear Editor of Medicina Oral, Patología Oral y Cirugía-Bucal,

I am a pathologist interested in DNA plody analysis applications in oncology. I read with much interest the paper "DNA cytometry of oral leukoplakia and oral lichen planus", published in the Volume 10, Supplement 1, pp. 9-14 of your journal.

From the careful reading, some comments have been arisen:

1. The Authors declared that biopsies were taken for each lesion using an 8 mm punch, and subsequently divided into two parts, presumably of 4 mm each one. I believe that a 4 mm sample could be too tiny to allow an accurate examination, both histological and cytometric. I wonder why more extensive biopsies did not be taken. Moreover, I marvel at the Ethical Committee approved a study in which potentially premalignant lesions (mostly oral leukoplakia) have been undergone possibly not accurate diagnosis analyses.

2. The tools used for DNA cytometry (i.e. the microspectrophotometer UMSP 30 and the image analyser IBAS 2000) are by now obsolete and actually superseded by more innovative and advanced ones, and I am very surprised at there are laboratories still using them. So, I would be curious about the laboratory where the Authors executed the DNA cytometric analyses, since in the paper it is not indicated.

3. The Authors declared that patients with erosive lichenplanus have been treated with local radiotherapy. I believe that radiotherapy is certainly not suitable nor recommended to treat erosive oral lichen planus.

I am certain that the Authors will be able to clarify my perplexities; if no, my insinuating suspicion of a fancy paper will be strengthened.

With kind regards
Philippe Martin
63000 Clermont-Ferrand, France


Answer to the first Letter

We were delighted at the interest in our article published in Med Oral Patol Oral Cir Bucal...Femiano F, Scully C. DNA cytometry of oral leukoplakia and oral lichen planus.Med Oral Patol Oral Cir Bucal. 2005 Apr 1;10 Suppl 1:E9-14, and for questions raised.

1. The biopsy with the 8mm biopsy punch forms part of a preestablished protocol. This is enough to allow histological investigation and for the preparation of slides with Feulgen dye for analysis by DNA cytometry.

In relationship to the comment: "Moreover, I marvel the Ethical Committee approved a study in which potentially premalignant lesions (mostly oral leukoplakia) have been undergone possibly not accurate diagnosis analyses". In this and for this research our patients have of course always received an accurate histopathological diagnosis.

2. It is correct that the instruments used for DNA cytometry are now obsolete but this research began many years ago (see Gombos F, Serpico R, Femiano F, Zabatta A, Chiacchio R. The quantitative assessments of DNA in potentially cancerous cases of oral lichen Minerva Stomatol. 1993 Jun;42(6):257-64) and therefore, in order to achieve uniform data, we chose to continue with the identical procedures.

3. We can confirm that radiotherapy has not been used for treating lichen planus but has been used where there has been dysplasia unable to be eliminated with surgery alone. Laser has also been used (Trehan M, Taylor CR. Lowdose excimer 308-nm laser for the treatment of oral lichen planus. Arch Dermatol. 2004 Apr;140(4):415-20. Passeron T, Ortonne JP. The 308 nm excimer laser in dermatology Presse Med. 2005 Feb 26;34(4):301-9. Kollner K, Wimmershoff M, Landthaler M, Hohenleutner U. Treatment of oral lichen planus with the 308-nm UVB excimer laser--early preliminary results in eight patients. Lasers Surg Med. 2003;33(3):158-60)

Dr. Felice Femiano
Professor of Oral Immunopathology
Stomatology Clinic.
II University of Medicine and Surgery

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