The Malignant Shift: Deciphering Clinical Predictors of Histological Dysplasia in Oral Mucosal Lesions

Abstract

Background: Oral mucosal lesions are diverse potentially malignant conditions that have varying risks of progression to oral squamous cell carcinoma. Although histological dysplasia is the most useful marker of malignant transformation, early clinical markers are vital for early diagnosis and intervention especially in resource-limited settings.

Objective: To determine clinical predictors associated with histological dysplasia in patients presenting with oral mucosal lesions.

Methods: The study was conducted in Department of Oral Medicine as an analytical cross sectional study for six months from July, 2025 to December, 2025. Patients with clinically suspected oral mucosal lesions were consecutively enrolled, resulting in 105 patients. The clinical assessment was performed in detail, including the type of lesions, their location, their colour, their surface characteristics, and risk habits. The data were analysed in SPSS version 24. The chi-square test and binary logistic regression were used and a p-value of ≤ 0.05 was taken to be statistically significant.

Results: A total of 53.3% cases showed histological dysplasia. Non-homogeneous lesion appearance, smoking, ulceration, induration, and lesions on the tongue and floor of mouth were significantly associated with dysplasia (p < 0.05). Non-homogeneous lesions (AOR 3.42), ulceration (AOR 4.15), induration (AOR 3.67), tobacco use (AOR 2.78), and high-risk sites (AOR 2.91) were independent predictors.

Conclusions: Histological dysplasia can be predicted from certain clinical characteristics in oral mucosal lesions. Prompt identification of these signs of high risk may help to timely biopsy and thus to prevent malignant transformation.