Dermatoglyphic Study in Oral Cancer and Precancerous Patients

Transcription

1 Original Research Article Dermatoglyphic Study in Oral Cancer and Precancerous Patients Dr. Daya Shankar 1, Dr. Shivendra Choudhary 2, Dr. Sobhana Chandra 3, Dr. Medha Nanda 4, Dr. Gayatri Bharti 5 1 Senior Resident, Department of Dentistry, Patna Medical College & Hospital, Patna, India 2 MDS, Associate Professor, Department of Dentistry, Patna Medical College, Patna, Bihar 3 Professor, Department of Operative dentistry & Endodontics, Purvanchal Institute of Dental Sciences, Gorakhpur, Uttar Pradesh, India 4,5 Consultant Dental Surgeon, Prabha Dental Clinic, Hajipur, Bihar, India ABSTRACT Dermatoglyphic analysis is now beginning to prove itself as an extremely useful tool for preliminary investigations into condition with a suspected genetic basis. In many respects, it has been used as an adjunct to other disciplines, serving as a vehicle to resolve broader biomedical problems. This study is undertaken to determine whether specific dermatoglyphic patterns exists which help in predicting the oral cancer and precancerous lesion and condition. Herby our study concluded that dermatoglyphic pattern may have role in identifying individual either with or at risk for developing precancerous lesion, conditions and oral cancer. So it can be used as economical marker for oral cancer and precancerous patients. INTRODUCTION Dermatoglyphic are dermal ridge configurations/pattern on digits, palm, sole. Cummins in 1926 first introduced the term dermatoglyphics which refers to the study of the naturally occurring patterns of the surface of the hands and feet1. These patterns are fully formed 16 weeks after conception and do not changes till the rest of life. Widespread interest in epidermal ridge developed only in the last several decades when it became apparent that many patients with chromosomal aberration had unusual ridge formation. Unusual ridge configuration have been source to exist not only in patient with chromosomal defect but also in patient with precancerous and cancerous condition2,3. The aim of this study was to determine the association between digital dermatoglyphics of the hands with cancerous and precancerous condition. The present study is conducted to analyze the palmar dermatoglyphic in oral cancer and precancerous condition and find a dermatoglyphic as a marker. MATERIALS AND METHODS The present cross sectional study was carried out on the patients who attended the different private clinic for their dental needs. 90 individuals were selected and divided into three groups. Group 1 consisted of 30 patients with history of tobacco/areca nut intake with occurrence of oral squamous cell carcinoma (SCC). Group 2 had 10 patients with history of tobacco/ areca nut intake with occurrence of oral sub mucous fibrosis (OSMF) and occurrence of precancerous lesion and condition. In group 3 had 30 patients without habit of tobacco/areca nut, without any evidence of oral lesions were taken while, that served as control. Selection criteria were the patients giving positive history of tobacco/areca nut chewing for more than 1 year, with or without use of tobacco in other forms, presence of ulcerated lesion, red and white patch or exophytic growth on oral mucosa for group 1, restricted oral opening with palpable fibrous bands and/or burning sensation of mucosa for group 2. All the cases were confirmed by histopathological examination. An exclusion criterion was patients with scars or any injury to palms and patients with any systemic diseases. Patients were informed in detail about the study and their informed consent was obtained to conduct the study. A structured format was designed, which consisted of demographic data, detailed history of habits, medical history, Subjects were asked to wash Page 1

2 their hands with soap and water to remove any dirt or oil. Palmer prints were taken by using standard ink method proposed by Strong by using blue impression ink ( Camel India Limited, Mumbai) as in fig.1, Thick white printing paper (Berga image, A4 size, 100 g/m2) in fig.2, roller, glass inking slab and sponge pad4. The finger and palmer prints (fig.2) were analyzed qualitatively and quantitatively using Cummins, Mildo and Penrose method 5,6. Various parameters studied were fingertip print patterns, in which it is categorized into five types-arches, ulnara, radial loops, true whorls and composite whorls (fig.3)7. Fig.1: Blue Impression Ink ( Camel India Limited, Mumbai) Fig.2: The finger and palmer print on white printing paper (Berga image, A4 size, 100 g/m2 Fig.3 : 1) Right loop; 2) Left loop; 3) Plain whorl; 4) Central pocket whorl; 5) Double loop; 6)Accidental whorl RESULTS The demographic data of fingerprint pattern in the study group is described in table 1. There was significant increase in ulnar loop in group 1 (cancerous patients) and group 2 (precancerous patients). Ulnar loop pattern is found to be more significant in F1, F9, and F10 comparative to other fingers of the same group. In left little finger denoting as F1 (76.7 %) 46 of ulnar loop pattern was found in oral cancer patients and (50.0% ) 30 was found in precancerous patients and also in F9 (76.7%) 46 of ulnar loop pattern was found in oral cancer patients and (53.3%)32 in precancerous patients a. In right little finger denoting as F10 (66.7%) 40 in cancerous and (86.7%) 52 in precancerous patients in right little finger. Page 2

3 Table 1: Distribution of dermatoglyphic pattern according to different fingers Groups FINGER 1 Total ARCHES ULNAR RADIAL COMPSITE TRUE LOOP LOOP WHORL WHORL Group 1 6(10.0%) 46(76.7%) 0(0)% 0 (0)% 8(13.3%) 60(33.3%) Group 2 12(6.7%) 30(16.7%) 0(%) 2(1.1%) 16(8.9%) 60(33.3%) Group 3 6(3.3%) 28(15.6%) 8(4.4%) 6 (3.3%) 12(6.7%) 60(33.3%) Total 24(13.3%) 104(57.8%) 8(4.4%) 8(4.4%) 86(20.0%) 180(100.0%) Table 2: Logestic regression of FINGER 2 Group 1 8(4.4%)30(16.7%) 6(3.3%) 2(1.1%) 14(7.8%) 60(33.3%) Group 2 4(2.2%)38(21.1%) 6(3.3%) 0(0%) 12(6.7%) 60(33.3%) Group 3 2(1.1%)24(13.3%) 2(1.1%) 10(5.67%) 22(12.2%) 60(33.3%) Total 14(7.8%)92(51.1%) 14(7.8%) 12(6.7%) 48(26.7%) 180(100.0%) FINGER 3 Group 1 4(2.2%) 30(16.7%) 4(2.2%) 4(2.2%) 18(10%) 60(33.3%) Group 2 12(6.7%) 40(22.2%) 4(2.2%) 0(0%) 4(2.2%) 60(33.3%) Group 3 12(6.7%) 20(11.1%) 2(1.1%) 8(4.4%) 18(10.0%) 60(33.3%) Total 28(15.6%) 90(50.0%) 10(5.6%) 12(6.7%) 40(22.2%) 180(100.0%) FINGER 4 Group 1 12(6.7%) 32(17.8%) 8(4.4%) 0(0%) 8(4.4%) 60(33.3%) Group 2 8(4.4%) 22(12.2%) 4(2.2%) 8(4.4%) 18(10.0%) 60(33.3%) Group 3 14(7.8%) 20(11.1%) 2(1.1%) 4(2.2%) 20(11.1%) 60(33.3%) Total 34(18.9%) 74(41.1%) 14(7.8%) 12(6.7%) 46(25.6%) 180(100.0%) FINGER 5 Page 3

4 Group 1 6(3.3%) 24(13.3%) 0(0%) 8(4.4%) 22(12.2%) 60(33.3%) Group 2 14(7.8%) 14(7.8%) 2(1.1%) 4(2.2%) 26(14.4%) 60(33.3%) Group 3 10(5.6%) 20(11.1%) 6(3.3%) 12(6.7%) 12(6.7%) 60(33.3%) Total 30(16.7%) 58(32.2%) 8(4.4%) 24(13.3%) 60(33.3%) 180(100.0%) FINGER 6 Group 1 8(4.4%) 28(15.6%) 0(0%) 4(2.2%) 20(11.1%) 60(33.3%) Group 2 4(2.2%) 26(14.4%) 0(0%) 6(3.3%) 24(13.3%) 60(33.3%) Group 3 8(4.4%) 16(8.9%) 8(4.4%) 14(7.8%) 14(7.8%) 60(33.3%) Total 20(11.1%) 70(38.9%) 8(4.4%) 24(13.3%) 58(32.2%) 180(100.0%) FINGER 7 Group 1 12(6.7%) 22(12.2%) 0(0%) 4(2.2%) 22(12.2%) 60(33.3%) Group 2 0(0%) 30(16.7%) 2(1.1%) 4(2.2%) 24(13.3%) 60(33.3%) Group 3 0(0%) 38(21.1%) 4(2.2%) 0(0%) 18(10.0%) 60(33.3%) Total 12(6.7%) 90(50.0%) 6(3.3%) 8(4.4%) 64(35.6%) 180(100.0%) FINGER 8 Group 1 4(2.2%) 38(21.1%) 2(1.1%) 6(3.3%) 10(5.6%) 60(33.3%) Group 2 4(2.2%) 40(22.2%) 0(0%) 6(3.3%) 10(5.6%) 60(33.3%) Group 3 8(4.4%) 34(18.9%) 4(2.2%) 0(0%) 14(7.8%) 60(33.3%) Total 16(8.9%) 112(62.2% 6(3.3%) 12(6.7%) 34(18.9%) 180(100.0%) FINGER 9 Group 1 4(2.2%) 46(25.6%) 0(0%) 2(1.1%) 8(4.4%) 60(33.3%) Group 2 8(4.4%) 32(17.8%) 0(0%) 0(0%) 20(11.1%) 60(33.3%) Group 3 0(0%) 32(17.8%) 6(3.3%) 2(1.1%) 20(11.1%) 60(33.3%) Total 12(6.7%) 110(61.1%) 6(3.3%) 4(2.2%) 48(26.7%) 180(100.0%) FINGER 10 Page 4

5 Group 1 4(2.2%) 40(22.2%) 0(0%) 4(2.2%) 12(6.7%) 60(33.3%) Group 2 0(0%) 52(28.9%) 0(0%) 0(0%) 8(4.4%) 60(33.3%) Group 3 4(22.8%) 42(23.3%) 0(0%) 2(1.1%) 12(6.7%) 60(33.3%) Total 8(4.4%) 134(74.4% 0(0%) 6(3.3%) 32(17.8%) 180(100.0%) There is only a slight variation in frequency of radial loops and compound whorls in the three groups. There was significant less number of true whorl pattern in left little finger F1, left forefinger F4 and right little finger F10 in cancerous patients as compare to precancerous group and control. DISCUSSION The term dermatoglyphic (Skin Casings) was coined in 1926 (Cummins & Midlo) to describe what until then had been referred to as epidermal ridge configuration. The dermal ridges have various notable characteristics which make them important, not only in personal identification, but also in human biology for various reasons. Firstly, unlike many bodily traits the dermal ridges and configuration once formed remain unchanged except in dimensions, i.e. they are age stable. The ridges are environment stable and begin to appear from 5th month of embryonic life. Although the patterns formed by ridges vary in size, shape and detailed structures, still they can be classified into definite main types. The dermatoglyphic features can thus be exploited quantitatively and qualitatively to be genetic marker of a disorder. At present, there is an agreement that dermatoglyphic features confirm to polygenic system with individual genes contributing a small additive9. After Cummins, earth shattering discovery of simons creases found in down syndrome patients in There was a great move in dermatoglyphic field from a place of obscurity to being acceptance as a diagnostic tool among medical personnel. Since, then widespread interest in epidermal ridges developed in medical field. Squamous cell carcinoma (SCC) is a widespread disease associated with considerable amount of morbidity and mortality. It is a major worldwide health problem and the number of sufferings is increasing rapidly due to more and more people embracing deleterious habits such as tobacco chewing, smoking and alcohol abuse. Although the etiology is multifactorial, but regardless of the accelerating factors, neoplasm is thought to arise clonally from transformed cells that have undergone specific genetic and epigenetic alterations in oncogenes or tumor suppressor genes. Many gene alterations have been implicated in the development and progression of squamous cell carcinoma (SCC) and the stages of carcinogenesis have been clearly defined.[10] Unusual ridge configuration has been observed to exist not only in patients with chromosomal defect but also in patient with single gene disorder and in few in which the genetic basis of the disorder is unclear8. In examining dermatoglyphics and cancer patients in present study, there was increase in ulnar pattern which is also similar with the study done by Gupta A9. Another result in present study was about decrease in radial loops, which was also found similarly in study done by Atasu M, TeLata H.11 in 201 turkish patient and by Venki E2 on indian population. In the study done by Veena HS et al12, Gupta A8 and Venki E2 found that there is an increase in arch pattern in OSMF patients, whereas in our present study, there was no such variations with arches was recorded. There is no significant difference in finger tip pattern among the cancer and precancerous patient when they were compared together but significant differences were observed when individual finger of right and left hand of groups were compared which was also reported by various studies. Interestingly in present study when we compared individual fingers of right and left hand of groups for predicting fingers of oral cancer and precancerous patients, results showed high ulnar loops on fingertips of F1 (76.7% in oral cancer and 50.0% in precancerous group), F9 (76.7% and 53.3%), F10 ( 66.7% in oral cancer and 86.7% in precancerous group. But In another study there was no such result found, on other hand there was decrease in true whorl pattern on left little finger F1(13.3% in oral cancer and 26.7% in precancerous group), F4 (13.3% and 30.0% ),F10 ( 20% in oral cancer and 13.3%precancerous group) as compare to control. Among these fingers F1 was only, found to be predicting finger specifically for OSMF patients in one of the previous study done by Tamgire DW13 In which, there was Increase in true whorl pattern on right thumb in OSMF patients than control and decrease in radial loop on left forefinger in OSMF patients12. Fewer radial loop patterns on F1, F2, F3, F4 of left hand and F7 of right hand was observed in one of the study carried out by Soni A, Singh S K, Gupta A14 but in present study there was no such observation was found to correlate. In present study there was only a slight variation in frequency of radial loops and compound whorls in cancer and precancerous group and control which is similar with the study done by Gupta A9. Page 5

6 CONCLUSION The present study on dermatoglyphic patterns of patients with oral cancer and preacancerous lesion revealed some significant parameters which may be used as dermatoglyphic predictors. On comparing the intergroup findings and (individual fingers of both hands),the following parameters were observed-increase in ulnar loop on finger tips in cancerous and precancerous patients, specifically high in left little finger, right ring finger and right little finger. So these predicting fingers may be used as dermatoglyphic markers for oral cancer and precancerous patients. Our study concluded that dermatoglyphics pattern may have role in identifying individual either with or at risk for developing precancerous leions, conditions and oral cancer. So, early primary and secondary preventive measures can be taken. But further multicentric studies must be conducted in larger population with age, gender, race matched controls. REFERENCES [1]. Cummins H, Midlo C. Fingerprints, Palms and Soles: An Introduction to Dermatoglyphics. New York: Dover Press; p [2]. Venki E. Palmar dermatoglyphics in oral leukoplakia and OSC patients: Reviewed at Rajiv Gandhi Institute of Medical Science. Karnatka ; [3]. Umana U et al. Dermatoglyphics and cheiloscopic pattern in cancer patients;a study done in ABUTH Zaria, Nigeria; Current Research Journal of Biological Sciences2013 5(5): , [4]. Strong AM. An improved method of palm printing. Science 1929;69;250-1 [5]. Penrose LS. Memorandum on dermatoglyphic nomenclature. Birth Defects orig. artic search. 1969;6;72-84 [6]. Penrose LS. Fingerprints and palmistry. Lancet 1973;1: [7]. Latti BR et al. Palmistry in Dentistry. Latti BR, Kalburge JV. Palmistry in Dentistry. J Adv Med Dent Scie 2013;1(2): [8]. Schaumann B, Alter M. Dermatoglyphic in medical disorder ;1976:27-87 [9]. Gupta A, Karjodkar FR. Role of dermatoglyphics as an indicator of precancerous and cancerous lesions of the oral cavity. Contemp Clin Dent 2013; 4: [10]. Mavalwala J, Cumins H. The birth, growth and development of dermatoglyphics, Am J Philips Anthrop:1975;42: [11]. Atashu M, Telata H. Cancer & dermatoglyphics, Lancet 1968; [12]. Veena HS. Study of palmer dermatoglyphic in oral submucous fibrosis. Journal of anatomical society of india;2004-5, Vol 54(2); [13]. Tamgire DW et.al. Qualitative dermatoglyphic analysis of finger tip pattern in patient of OSMF. Journal of dental and medical sciences;2013, 6 (5):24-27 [14]. Soni A, Singh S.K Gupta. Implication of Dermatoglyphic in dentistry. Journal of dentofacial science,2013;2(2):27-30 Page 6