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Oral mucosal color changes as a clinical biomarker for cancer detection

Latini, Giuseppea,e; De Felice, Claudiog; Barducci, Alessandroh,i; Chitano, Giovannab; Pignatelli, Antoniettac; Grimaldi, Lucad; Tramacere, Francescoc; Laurini, Ricardoj; Andreassi, Maria Graziaf; Portaluri, Maurizioc,e

European Journal of Cancer Prevention: July 2012 - Volume 21 - Issue 4 - p 360–366
doi: 10.1097/CEJ.0b013e328350de51
Research Papers: Head and Neck Cancer

Screening is a key tool for early cancer detection/prevention and potentially saves lives. Oral mucosal vascular aberrations and color changes have been reported in hereditary nonpolyposis colorectal cancer patients, possibly reflecting a subclinical extracellular matrix abnormality implicated in the general process of cancer development. Reasoning that physicochemical changes of a tissue should affect its optical properties, we investigated the diagnostic ability of oral mucosal color to identify patients with several types of cancer. A total of 67 patients with several histologically proven malignancies at different stages were enrolled along with a group of 60 healthy controls of comparable age and sex ratio. Oral mucosal color was measured in selected areas, and then univariate, cluster, and principal component analyses were carried out. Lower red and green and higher blue values were significantly associated with evidence of cancer (all P<0.0001), and efficiently discriminated patients from controls. The blue color coordinate showed significantly higher sensitivity and specificity (96.66±2.77 and 97.16±3.46%, respectively) compared with the red and green coordinates. Likewise, the second principal component coordinate of the red–green clusters discriminated patients from controls with 98.2% sensitivity and 95% specificity (cut-off criterion≤0.4547; P=0.0001). The scatterplots of the chrominances revealed the formation of two well separated clusters, separating cancer patients from controls with a 99.4% probability of correct classification. These findings highlight the ability of oral color to encode clinically relevant biophysical information. In the near future, this low-cost and noninvasive method may become a useful tool for early cancer detection.

aDivision of Neonatology, Perrino Hospital

bEuro Mediterranean Scientific Biomedical Institute (ISBEM)

cRadiotherapy Department, ASLBR

dMedical Physics, Perrino Hospital ASL Brindisi, Brindisi

eClinical Physiology Institute, National Research Council of Italy (IFC-CNR)

fGenetics Research Unit, CNR Institute of Clinical Physiology, Pisa

gNeonatal Intensive Care Unit, Le Scotte University General Hospital

hDepartment of Information Engineering, University of Siena, Siena

iInstitute for Applied Physics ‘Nello Carrara’, National Research Council of Italy, Florence, Italy

jInstitute of Clinical Medicine, University of Tromsø, Tromsø, Norway

Correspondence to Giuseppe Latini, MD, Division of Neonatology, Perrino Hospital, Ospedale A. Perrino, s.s. 7 per Mesagne, 72100 Brindisi, Italy Tel: +39 0831 537471; fax:+39 0831 537861; e-mail:

Received October 6, 2011

Accepted December 23, 2011

© 2012 Lippincott Williams & Wilkins, Inc.