I have read with much interest Di Iorio’s article entitled “Esophytic palatal lesion in partially edentulous patient”  which introduces a hyperplastic growth, with keratosis, secondary to the exposure to a chronic trauma.
The lesional growth was diagnosed as “irritation fibroma”. The manuscript focuses on highlighting the reactive nature, unlike the designation may imply, and emphasizes on the benignancy of the condition. In this connection, I totally agree on the reactive nature of the connective tissue changes.
Yet, the epithelial alterations represent the most crucial caveats because dysplasia and keratosis, even simple keratosis, may indicate the potential transition to dysplasia. The great majority of simple keratoses have revealed, moreover, losses of 3p14 and 9p21 which is remarkable in the early tumorigenesis of squamous cell carcinoma . Therefore, light should be focused, in similar conditions, on the epithelial alterations not on the fibrous changes of the connective tissue.
Bacem A.E.O. Khalele
Dear Dr. Bacem A.E.O. Khalele,
first I’d like to say it was a great pleasure to see your interest in the clinical case I presented [Di Iorio E. Lesione esofitica palatale in paziente parzialmente edentulo. Dental Cadmos 2016;84(1):5-6] and I want to thank you for the precious and constructive contribution. Moreover I’d like to show you my gratitude for having given me the opportunity to emphasize what you rightly pointed out.
For the oral ephitelium subject to chronic trauma is always possible the transition to keratosis, dysplasia and squamous cell carcinoma, the risk of epithelial alterations should be kept in consideration by dentists, oral pathologists and oral surgeons. I would like to use this chance to mention two concepts that I learnt from my teachers (first of all Prof. Adriano Piattelli) and which could be useful for both those who decide to deal with oral medicine and those, though not taking care of it directly, are daily involved with examining the oral cavity.
Any kind of oral damage that doesn’t heal within two weeks either spontaneously or following a specific therapy deserves a diagnostic study and every time you perform surgery to remove an oral lesion, histopathological examination of tissues removed should follow. It’s not easy to thoroughly discuss a case in the 2,500 fonts of a “Quesito diagnostico” and sometimes something important is left behind.
This time you did it for me, with your clarifying intervention and that’s why I want to thank you once again. Kind regards.
Enzo Di Iorio
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