Exfoliative Cytology in Evaluating Oral Lesions

¹ University of Wales, Cardiff, United Kingdom

Exfoliative cytology usually plays a minor supportive role in a properly planned and carefully executed biopsy for the diagnosis of oral cancer. The definitive diagnosis is made by biopsy. The early lesion are the operative words when assessing the value of diagnostic procedures in cancer; as yet, no investigator has shown exfoliative cytology to be of value in the diagnosis of non-ulcerative carcinoma of the mouth. In the diagnosis of early cancer, it is the disturbed relationship of one cell to another that is important, and these subtle changes can be observed only in tissue sections. Exfoliative cytology gives the most help in the diagnosis of bullous lesions. In pemphigus vulgaris and vegetans a biopsy is still mandatory, epithelial smears providing valuable confirmatory evidence. True Tzanck cells are not easily found even in florid cases, but all transitions to normal cells are observed. These smears show a profusion of multinucleated cells, the result of the great reparative powers of the oral mucosa. Epithelial smears from intact or recently ruptured oral bullae, from cases of herpes simplex and zoster, are diagnostic. Even under lower power, the affected cells show ballooning degeneration and multinucleated cells with twenty or more nuclei. The small eosinophilic intranuclear body of Lipschütz is only rarely seen.