Does the risk of malignant transformation increase with the dysplasia grade in potentially malignant lesions like leukoplakia?

• A. It is unpredictable
• B. Yes; higher dysplasia increases risk
• C. No
• D. Only in smokers

Answer: (B)

In leukoplakia and other potentially malignant oral lesions, the grade of dysplasia reflects how abnormal the epithelial cells are and how disrupted their growth architecture has become. As you move from mild to moderate to severe dysplasia, those cellular changes become more pronounced and more likely to progress toward cancer. So, the higher the dysplasia grade, the greater the risk that the lesion will undergo malignant transformation. This is why grading helps guide monitoring and treatment decisions. Remember that risk isn’t zero even for low-grade lesions, and other factors like lesion location, size, and patient factors (smoking, alcohol use) also influence risk, but the general pattern is increased risk with higher dysplasia.