Premalignancy

Premalignancy refers to tissue changes that are not yet cancer but carry an increased risk of developing cancer if left untreated. Premalignant lesions are typically characterized by dysplasia or metaplastic changes that alter cellular architecture and genetic regulation, without invasion into surrounding tissues. The degree of dysplasia often guides risk assessment and management decisions.

Common premalignant conditions include cervical intraepithelial neoplasia and other cervical dysplasias, actinic keratosis of the skin, Barrett esophagus with dysplasia, oral leukoplakia, laryngeal dysplasia, and colonic adenomatous polyps. These conditions reflect abnormal cellular growth that could progress to malignancy over time, though many premalignant lesions remain stable or regress, especially with intervention or risk factor modification.

Progression from premalignancy to cancer is influenced by genetic and environmental factors, host immunity, and lesion-specific biology. Not all premalignant changes become cancer; effective screening and timely treatment reduce progression risk. Diagnosis relies on tissue sampling and histological grading to determine the presence and severity of dysplasia.

Management typically involves removal or destruction of the abnormal tissue when feasible, along with surveillance to detect any progression. Prevention strategies include risk-factor modification (for example, cessation of smoking), vaccination against oncogenic viruses (such as HPV to reduce cervical premalignant disease), and appropriate screening programs (such as Pap tests and colonoscopy) to identify lesions at an early, curable stage.

Prognosis depends on the lesion type, grade of dysplasia, and success of treatment. Early detection and complete removal or ablation of premalignant tissue markedly improve outcomes.