Pathology of the Head and Neck

Lesions of Squamous Epithelium Chapter 1 29cally, molecular pathology could be decisive in makingthe distinction. Such a clonal marker should be differentin different tumours and not subject to alterations duringtumour progression and metastasis. The p53 genemeets these requirements; other markers such as lossof heterozygosity analysis are less stable [271, 347, 358,359]. Only in tumours lying close to each other p53 mutationanalysis may be unreliable as separate tumoursdeveloping within a single neoplastic field may have thesame p53 mutation [50]. This, however, does not detractfrom the main value of p53 gene analysis as a tool to distinguishbetween lung lesions as distant metastasis fromSCCs of the head and neck or second primary cancer inthe lung.1.6.3 Assessment of Riskof Malignant ProgressionSquamous cell carcinomas of the head and neck may bepreceded by premalignant alterations showing epithelialchanges of varying degrees. Molecular pathology hasbeen shown to be helpful in identifying lesions at riskof further malignant progression. Chromosomal lossesat loci 3p and 9p have been shown to occur in mucosallesions that subsequently turned into cancer, but as notall of the lesions with these genetic alterations progress,other changes also play a role: additional chromosomallosses, chromosomal polysomies and p53 protein expression[204, 306]. Also, suprabasal expression of p53protein and the presence of cells with abnormal DNAcontent predict malignant transformation, even in theabsence of overt morphologic epithelial alterations [82,344].1.6.4 DNA/RNA Profilingin Predicting Metastatic DiseaseDNA alterations and RNA expression profiles could beuseful in distinguishing between patients with SCCs ofthe head and neck with and without lymph node metastasis,thus diminishing the number of elective neck dissectionsin N0 patients. Data on this issue are just beginningto appear. 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