Among one hundred patients with oral cancer in Trivandrum, South India, 40 suffered from oral submucous fibrosis, a chronic condition characterized by blanching and stiffness of the oral mucosa. Histologically, submucous fibrosis is associated with a marked atrophy of the oral epithelium. Oral biopsies were taken from 30 patients, either in areas remote from the cancer or in the vicinity of the cancer. Epithelial atypia was observed in 11.5% in areas remote from the cancer and in 71.4% in the vicinity of the cancer. Though the biopsies were taken from areas normally unkeratinized, the majority revealed keratinization in varying degrees. Clinically, Ieukoplakias were found in 46.7%. Since all patients chewed tobacco, it is most likely that the epithelial changes and the cancers are the results of this habit, primarily because the atrophic oral epithelium in submucous fibrosis is more vulnerable to action of carcinogens. T h e authors postulate that submucous fibrosis is due to a hypersensitivity to chilli, a theory supported by the occurrence of submucous fibrosis among chillieating populations in South East Asia.
UBMUCOUS FIBROSIS IS AN ORAL CONDITION
S described first by JoshiZ and reported mainly among Indians. Reviews of the available literature recently have been published.7-8,12 T h e condition is chronic and is clinically characterized by blanching of the oral mucosa, associated with stiffness of the mucosa (Fig. 1). I n some cases vesicle formation also occurs. I n severe cases the patients have marked difficulties in chewing, swallowing and speaking. Most of the affected patients exhibit a pronounced atrophy of the tongue papillae.
P a y m a ~t e r , ~ reporting from Bombay, described the development o f a slow-growing squamous cell carcinoma in one third of his patients with submucous fibrosis: Sirsat and Khanolkar,l2 on the other hand, also working among Bombay patients, could not support Paymaster's findings.