René Panico

Objective: Epidemiological and survival data on osteosarcoma of the jaws (OSJ) in Latin America remain scarce. We characterized the clinicopathological, radiographic, treatment‐related, and survival features of OSJ in Latin America. Methods: This multicenter case series involved 22 institutions from Brazil, Chile, Argentina, Colombia, Venezuela, Uruguay, and Mexico. Demographic, clinical, radiographic, histopathological, treatment, and survival data were analyzed using descriptive and inferential statistical methods. Survival outcomes were assessed using Kaplan–Meier analysis and Cox regression models. Results: A total of 119 OSJ cases were included. The median age was 33 years, with a female predominance (58%), and the mandible was the most commonly affected site (68.9%). A mixed radiographic appearance predominated and was frequently accompanied by cortical perforation and a sunburst periosteal reaction. Histologically, the osteoblastic subtype accounted for 63.5% of cases. Surgical resection was the main treatment modality (71.2%). Increasing age ( p = 0.034) and multimodal or nonsurgical management ( p = 0.023) were independently associated with poorer survival. The estimated overall survival rates were 67.5% at 12 months and 37.5% at 60 months. Conclusion: Data corroborate previous literature and demonstrate that OSJ in Latin America predominantly affects adults and exhibits aggressive patterns. Surgical management remains central to improving survival whenever it is technically feasible.

Objective: This study assessed the frequency and clinical features of MRONJ with exclusive palatal involvement at two Oral Medicine referral centers. Methods: A retrospective cross-sectional study included consecutive patients diagnosed with MRONJ between 2016 and 2025 at two referral centers in Córdoba, Argentina. Clinical records, imaging studies, and histopathological reports were reviewed. The frequency of exclusive palatal involvement was determined, and demographic, clinical, radiographic, and histopathological characteristics were analyzed descriptively. Results: Among 58 patients with MRONJ, 5 (8.6%) presented exclusive palatal involvement without concomitant maxillary or mandibular lesions. All patients were women (mean age, 78.4 years) receiving oral antiresorptive therapy for osteoporosis. Clinical findings ranged from mucosal breakdown to exposed necrotic bone with fistulization. Contributing local factors included prosthetic irritation and palatal exostoses. Imaging findings were often subtle or non-specific, whereas histopathological examination confirmed osteonecrosis when performed. Conclusion: Exclusive palatal MRONJ is an uncommon but clinically significant presentation. Awareness of this atypical location may facilitate earlier diagnosis and improve management in patients receiving antiresorptive therapy.

This study examines how local chronic inflammatory conditions, particularly oral dysbiosis, Candida-associated inflammation, and chronic mechanical irritation, may modify the clinical and histopathological presentation of oral potentially malignant disorders (OPMDs) and complicate their assessment in routine practice. This expert clinical perspective, supported by selected literature and representative clinical scenarios, addresses clinicopathological gray zones arising when OPMDs coexist with inflammatory and microbial disturbances. These conditions may accentuate erythema, ulceration, hyperkeratosis, epithelial hyperplasia, and reactive cytological atypia, potentially complicating the distinction between inflammation-associated changes and true oral epithelial dysplasia (OED). Oral dysbiosis and Candida-associated inflammation may further modify the local inflammatory microenvironment and lesion phenotype. Recognition of these modifiers may inform biopsy timing and site selection, histopathological interpretation, and communication between clinicians and pathologists. Local inflammatory and microbial modifiers should be considered when evaluating OPMDs, particularly when clinical and histopathological findings are equivocal or discordant. Careful clinicopathological correlation and further prospective studies are needed to clarify the interactions among oral dysbiosis, chronic inflammation, and epithelial alterations in OPMDs.

Background: Oral cavity squamous cell carcinoma (OSCC) remains a major public health challenge worldwide. In South America, its epidemiology is influenced by culturally embedded practices that remain underrepresented in the international literature. Aims: To critically examine region‐specific exposures that may contribute to oral carcinogenesis and to identify major knowledge gaps relevant to OSCC prevention and early detection in South America. Materials and Methods: This evidence‐informed position paper was developed through consensus among specialists from South American referral centers and a structured appraisal of the available literature, focusing on chimó use, coca leaf chewing, reverse smoking, hot mate consumption, and charcoal‐grilled meat intake. Results: Current evidence suggests that these practices involve biologically plausible mechanisms, including thermal injury, chronic mechanical irritation, exposure to potentially carcinogenic chemical compounds, and persistent mucosal inflammation, that may promote carcinogenesis. Discussion: The strength of the available evidence varies considerably across exposures, and several associations remain hypothesis‐generating and require further epidemiological, mechanistic, and molecular validation. Conclusion: This position paper identifies major knowledge gaps and proposes a regional research agenda aimed at improving risk assessment, prevention strategies, and the early detection of OSCC in South America.

Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organs, including the oral mucosa. Although SLE has been recognized as an oral potentially malignant disorder (OPMD), malignant transformation within lupus-related oral lesions is exceptionally rare. Case report: This report describes a 77-year-old woman with SLE who developed three synchronous oral carcinomas — two verrucous carcinomas and one conventional oral squamous cell carcinoma (OSCC) — after years of chronic, treatment-refractory mucosal lesions. Histopathological examination revealed multifocal epithelial dysplasia and carcinoma, suggesting a phenomenon of field cancerization (FC). The patient, who lacked classical risk factors such as tobacco or alcohol use, was treated successfully with radiotherapy, achieving complete remission and no recurrence after 18 months of follow-up. The present report highlights the potential role of chronic inflammation and long-term immunosuppression in oral carcinogenesis in SLE. It also underscores the diagnostic challenges in differentiating lupus lesions from other OPMDs and the importance of serial biopsies for early detection of dysplastic transformation. Conclusion: The coexistence of FC and SLE has not been previously reported, and this case contributes novel clinical and histopathological evidence supporting the inclusion of SLE among conditions predisposing to multifocal oral cancer.

Objetivo: Este estudio tiene como objetivo presentar un caso clínico de Mieloma Múltiple (MM) con una presentación oral inusual, subrayando la importancia de la vigilancia bucal en el diagnóstico integral de enfermedades hematológicas. Caso Clínico: Se presenta el caso de una paciente femenina de 70 años que acudió a la Cátedra de Estomatología "A" de la Facultad de Odontología de la Universidad Nacional de Córdoba con lesiones gingivales bimaxilares de 6 meses de evolución. La paciente, sin antecedentes patológicos conocidos, presentó pérdida de peso significativa y síntomas sistémicos graves. Al examen clínico, se observaron masas hiperplásicas gingivales dolorosas, con movilidad dental generalizada. La ortopantomografía y la tomografía revelaron reabsorción alveolar y áreas osteolíticas. Los análisis de laboratorio mostraron anemia, leucopenia, trombocitopenia, y marcadores inflamatorios elevados. La biopsia reveló una proliferación de células plasmáticas monoclonales positivas para CD38 y cadenas kappa, lo que llevó al diagnóstico de MM. La paciente fue remitida a oncohematología, pero falleció rápidamente. Conclusión: Este caso destaca la importancia del reconocimiento temprano de manifestaciones orales de MM, que pueden ser un desafío diagnóstico debido a su similitud con otras afecciones orales comunes. La identificación oportuna de estas lesiones por parte de los odontólogos puede ser crucial para reducir la morbilidad y mortalidad asociadas a esta enfermedad hematológica.

Background: Oral melanoma is a rare and aggressive malignant neoplasm that typically exhibits variable degrees of pigmentation. Amelanotic variants further complicate clinical diagnosis by mimicking non-neoplastic lesions. The present study aimed to describe the clinicopathological characteristics, management, and outcomes of oral melanoma in South America. Methods: This collaborative retrospective study included cases diagnosed between 2003 and 2025 from five oral pathology and oral medicine centers in Argentina, Venezuela, Colombia, and Brazil. Clinicopathological, treatment, and follow-up data were analyzed descriptively. Results: Twenty-one cases of primary oral melanoma were analyzed. The mean age was 63.0 years, with a slight female predominance (52.4%). Most lesions were asymptomatic at diagnosis (78.3%) and involved the palate/maxillary gingiva (66.7%). Clinically, tumors (37.9%) and macules (27.6%) were the most frequent presentations. Histologically, melanotic melanoma predominated (76.2%). Melan-A, HMB-45, SOX10, and S-100 protein were the most frequently used immunohistochemical markers. Surgical resection was performed in 85.7% of cases. During follow-up, 52.6% of patients died. Conclusion: Data corroborate the clinicopathological profile of oral melanoma and expand current knowledge by documenting novel South American cases, underscoring its marked clinical heterogeneity, poor prognosis, and the critical importance of early recognition.

Objetive: The aim of this study is to describe Vitamin D3 levels in patients diagnosed with MRONJ from two centers in Argentina. Methods: A cross-sectional study was conducted on patients from two Oral Medicine centers in Argentina. Patients diagnosed with Medication-related osteonecrosis of the jaw between 2016 and 2022 were included. Vitamin D3 levels were measured in plasma. The STROBE guidelines for reporting cross-sectional studies were followed. Results: The final sample consisted of 53 individuals. Among them, 60.4% had oncological-based diseases while 39.6% were diagnosed with osteoporosis. Oncological patients with Medication-related osteonecrosis showed lower vitamin D3 levels (23.9 ng/mL) compared to the osteoporosis group (32.9 ng/mL) (p=0.03). Conclusion: These preliminary findings described the levels of vitamin D3 in patients diagnosed with MRONJ, highlighting the relevance of investigating the role of vitamin D3 and its clinical outcomes in these patients. Future research in this area could provide valuable insights for a comprehensive understanding of this role.

Childhood Pemphigus Vulgaris is a rare entity, with an estimated incidence of 0.1–0.5 cases per 100,000 inhabitants per year, occurring between the ages of 13 and 19 years, with clinical and pathological features resembling those seen in adults. Clinical manifestations include the presence of flaccid, painful blisters, and secondary erosions affecting the skin and mucous membranes, particularly the oral mucosa. To date, only about 50 cases of this entity have been reported in the literature. The diagnosis relies on clinical assessment, complemented by histopathological examination and direct immunofluorescence to identify the presence of antibodies. We report the case of a 3-year-old patient with mucocutaneous lesions of 8 months duration, highlighting the clinical features, interdisciplinary diagnostic approach, and the use of rituximab as a first-line therapeutic agent in Childhood Pemphigus Vulgaris. In addition, a concise review of the literature from the past decade was conducted, focusing on the clinical characteristics of the disease presentation, with particular emphasis on oral involvement.

Aim: The primary aim was to develop and test a telemedicine program for oral cancer screening by dentists in primary care. The secondary aim was to analyze the sensitivity of the provisional diagnosis compared to the definitive diagnosis. Methods: A retrospective observational study that used telemedicine for oral cancer case detection was conducted in Cordoba, Argentina from 2018 to 2023, oral medicine specialists provided in-person training for dentists on the clinical recognition and early diagnosis of oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD), and telemedicine use for the early detection of oral cancer. The trained professionals conducted opportunistic screenings in their workplaces. When encountering a suspicious lesion on the oral mucosa, they collected relevant patient data and clinical photographs of the lesion, sharing these with the reference center. The specialized center was based at the Oral Medicine unit at the Facultad de Odontología, Universidad Nacional de Córdoba, Argentina. The specialists suggested radiographic examinations and/or pre-surgical laboratory tests and, if necessary, expedited referral to the specialized center for in-person assessment and definitive diagnosis. Results: Cases with clinical suspicion of OSCC and OPMD were referred to the reference center. In all cases, the definitive diagnosis was obtained within less than 1 month. Eleven out of 12 cases of OSCC were diagnosed within 2 weeks, with only 1 case diagnosed at 1 month due to some patient delay. The concordance between the clinical suspicion at the time of teleconsultation and the definitive diagnosis of OSCC by the specialists was absolute (Kappa test, coefficient 1), with a sensitivity and specificity of 100%. Conclusions: Integrating telemedicine with other preventive strategies and timely referral to oral medicine specialists could potentially decrease diagnostic delays in OSCC and OPMD.