Beyond buccal cells: Systemic genotoxicity biomarkers enhance early detection and risk stratification in oral leukoplakia

Abstract

Oral leukoplakia (LPK), the most prevalent oral potentially malignant disorder, carries a 0.6-20% risk of malignant transformation to oral cancer (OC), with tobacco carcinogens being the primary etiological factor. Current diagnostic approaches are clinical examination and histopathological evaluation. Buccal cell micronucleus cytome (BMNCyt) assay effectively assess localized genotoxic damage but fail to evaluate systemic effects in LPK patients. The elevated incidence of chromosomal aberrations, cytokinesis-block micronucleus formation, and telomerase dysregulation reveals systemic genomic instability. These biomarkers detect molecular alterations preceding histopathological progression, providing an effective tool for early risk stratification and clinical intervention in LPK patients. Integrating these systemic markers with conventional diagnostics would enable comprehensive risk assessment by capturing both local and field cancerization effects. This combined approach provides a minimally invasive strategy to monitor tobacco's systemic genotoxicity while addressing current diagnostic limitations. Implementation could transform LPK management through earlier intervention and improved OC prevention.

Keywords: Oral leukoplakia, systemic genotoxicity, oral cancer risk prediction, combined biomarker panel