Assessment of Pattern of Oral Mucosal Lesion based on Histopathological Diagnosis at Tertiary Care Center of Nepal: A Prospective Cross-sectional Study
Harish Kumar Shah, Anand Chaurasia, Rupa Thakur, Rajesh Shah, Abhay Kumar, Abanish Singh
A
BSTRACT
Background:
Oral mucosal lesions (OMLs) represent a clinicopathologically diverse group of conditions involving the oral epithelium and underlying connective tissue, encompassing reactive, potentially malignant, benign, and malignant entities. Their occurrence reflects cumulative exposure to behavioral, environmental, and sociocultural determinants rather than uniform global patterns. Histopathology provides definitive tissue-level characterization and remains indispensable for accurate diagnosis. Despite a substantial regional burden of tobacco- and areca nut–related oral pathology in Nepal, particularly in Madhesh Province where these habits are widespread, systematic clinicopathological data on OMLs remain scarce. This study aimed to determine the histopathological patterns of OMLs and their associations with age, sex, habits, lesion site, and oncogenic potential.
Methods:
A prospective cross-sectional study was conducted from November 2023 to July 2025 in the Departments of Periodontology and Oral Implantology and Pathology National Medical College, Birgunj, Nepal. A total of 175 consecutively diagnosed OML cases were enrolled. Sociodemographic, clinical, and habit-related data were recorded. Biopsies were performed under aseptic conditions, and histopathological diagnoses were confirmed by two oral pathologists using WHO criteria. To assess oncogenic potential, lesions were dichotomized as “yes” for potentially malignant and malignant lesions, and “no” for reactive and benign lesions. Associations were analyzed using Chi-square tests, and logistic regression identified factors associated with oncogenic potential (
Results:
The mean age was 37.4 ± 14.1 years (range: 17–75), with 51.4% males. Most patients were aged 31–60 years (56.6%). Smokeless tobacco use was reported in 33.7%, smoking in 8.6%, and 57.7% had no harmful habits. Potentially malignant lesions predominated (57.7%), followed by reactive (29.1%), benign (10.3%), and malignant (2.9%) lesions. Oral submucous fibrosis (26.9%), lobular capillary hemangioma (26.3%), and oral lichen planus (24.6%) were most frequent. Logistic regression showed significantly elevated adjusted odds of oncogenic potential among patients aged 31–60 years (AOR 21.20), tobacco users (AOR 10.57), and those with multiple lesions (AOR 27.72), all
Conclusion:
Potentially malignant lesions, particularly oral submucous fibrosis, were predominant and demonstrated strong associations with smokeless tobacco exposure and male sex. Oncogenic potential increased significantly with age, tobacco exposure, and multiple lesions, emphasizing the need for focused cessation strategies, structured screening, and prompt biopsy in high-risk individuals.