clinical risk factors of leukoplakia in patients with a history of oral cancer is very important, because up to a third of oral cancer patients will develop a second oral malignancy (SOM), including tumor recurrence and second primary tumors, despite vigorous follow-up. Objective. To identify clinical indices that can be used to predict SOM development at treated cancer sites. Study design. We collected prospective clinical data on 74 patients with oral squamous cell carcinoma (SCC) or carcinoma in-situ (CIS) (treated with intent to cure) being followed in the Oral Dysplasia Clinic. Results. To date, 18 patients (24%) have developed an SOM at the treated cancer site (SOM group) within an average of 21 months. Follow-up time for the 56 patients who did not develop SOM (nonSOM group) is 32 months. There is no significant difference between the 2 groups with respect to demographic characteristics (age, gender), smoking history (% of smokers, average no. of pack-years, proportion of smokers who quit after diagnosis), and features of the primary oral cancer (TNM staging, histological grading and treatment, site of lesion). The presence of leukoplakia at the previous cancer site (mostly at the floor of mouth and ventrolateral tongue) significantly predicts cancer recurrence (78% in SOM group vs. 39% in nonSOM group, P = .0063), whereas the clinical appearance of the leukoplakia (P = 1.0), size of the leukoplakia (P = .717), and treatment of the lesions (82% surgery in SOM group vs. 78% in nonSOM group) did not. Conclusions. Presence of leukoplakia, even with homogeneous clinical appearance or small size, predicted tumor recurrence. The results suggest that, in cancer patients, the appearance of a leukoplakia at a previous cancer site should immediately provoke biopsy of the lesion even when the lesion seems clinically innocuous. Research supported by NIDCR Grant R01DE13124 and by scholarships from the Head and Neck Cancer Foundation. CYCLOOXYGENASE-2 EXPRESSION IN PREMALIG- NANT ORAL MUCOSAL LESIONS. R. Lalla, E. Eisenberg, K. Damato, D. Shafer, M. Goupil, J. Spiro, D. Peterson, University of Connecticut Health Center, Farmington. Background. Cyclooxygenase-2 (COX-2) mediates prostaglan- din synthesis and is a key enzyme in the inflammatory process. An increasing body of recent literature suggests that COX-2 may also play an important role in promoting cancer progression. COX-2 expression has been demonstrated to be upregulated in oral squamous cell car- cinoma, using immunohistochemistry and quantitative reverse trans- criptase polymerase chain reaction (RT-PCR). COX-2 expression has also been demonstrated to be upregulated in premalignant oral mucosal lesions, using immunohistochemistry and nonquantitative RT-PCR. However, to our knowledge, this increased expression has not been previously quantified and reported. Objective. The aim of this study was to quantify COX-2 expression in premalignant oral mucosal lesions compared to normal controls using quantitative RT-PCR. Study design. Punch biopsies of oral mucosal lesions clinically suspicious for oral premalignancy or malignancy were obtained from 12 subjects. Seven of these subjects also agreed to biopsy of clinically normal oral mucosa. Half of each biopsy was placed in formalin and submitted for histopathological examination by an oral and maxillo- facial pathologist. The other half of each biopsy was flash-frozen and subsequently analyzed for levels of COX-2 mRNA using quantitative RT-PCR. mRNA levels were expressed as fg/mg total RNA. mRNA levels between the premalignant and control groups were compared using a 1-tailed independent samples t-test. A P value of \.05 was considered statistically significant. Results. On histological examination of the 12 clinically suspicious oral lesions, 6 were diagnosed as dysplasia, 1 as carcinoma and 5 as neither dysplasia nor carcinoma. Of the 7 clinically normal tissue samples, 6 were histologically confirmed to contain neither dysplasia nor carcinoma. The mean COX-2 mRNA level in the 6 dysplastic oral mucosal lesions (mean = 196.66, SD = 259.13) was over 6 times higher than the mean COX-2 mRNA level in the 6 samples of normal oral mucosa (mean = 31, SD = 27.33). Although this difference did not achieve statistical significance, a statistical trend was observed (P = .09). Conclusions. We found an over 6-fold increase of COX-2 mRNA in premalignant oral mucosal lesions compared to normal oral tissues. The lack of statistical significance may be attributable to the small sample size and large standard deviation in the dysplasia group; study of a larger sample is needed. Data from the current study are directed to quantification of COX-2 in dysplastic lesions. Other investigators have correlated COX-2 expression with aberrant DNA content as a genetic risk marker of oral cancer. Quantification of COX-2 mRNA levels in oral dysplasia may be useful as a marker for identification of high-risk premalignant lesions that may respond to therapy using COX-2 inhibitors. This study was supported by NIH GCRC grant M01RR06192, NIH T32DE07302, and the Oral Diagnosis Research Development Fund at the University of Connecticut School of Dental Medicine. AN UNUSUAL CLINICAL PRESENTATION OF ORAL AMYLOIDOSIS. J. M. Laudenbach, E. T. Stoopler, F. Alawi, D. Wunder, T. P. Sollecito, University of Pennsylvania School of Dental Medicine, Philadelphia. Background. Amyloidosis is a disease in which proteinaceous material is formed and deposited in soft tissues and organs. The formation and deposition of the material is in response to various cell dyscrasias and/or inflammatory conditions. Classification of amyloid- osis is divided into primary and secondary diseases. The most common forms of primary amyloidosis are the immunoglobulin light chain– related (AL) and the familial transthyretin–associated (ATTR) types. Amyloid, found in secondary amyloidosis, is derived from serum amyloid A (SAA), an acute-phase protein produced in response to inflammation. Amyloid deposition classically occurs most commonly in the tongue and can result in macroglossia and a waxy, plaque-like formation. A previous retrospective study has suggested that the buccal mucosa may be a common site of amyloid deposition in the oral cavity. Case report. A 55-year-old female presented to the Oral Medicine service with a chief complaint of noticing ‘‘red dots’’ on her lower lip which were present for 1 month. The patient reported that the lesions occasionally presented on the upper lip as well. Citrus, salty, and spicy foods irritated the lesions. The patient denied blister formation associated with the lesions. The patient denied ocular, nasal, vaginal, or rectal lesions. The patient had a previous dermatologic evaluation for erythema on her left arm and received no formal diagnosis. The dermatologist biopsied the patient’s oral lesion and the initial pathological diagnosis was suggestive of a mucocele. The past medical history was significant for hypothyroidism. Her current medications included synthroid and, over the counter, black cohosh, soy supplement, and black licorice. There were no known drug allergies, and the patient reported tobacco use for the past 30 years and occasional alcohol use limited to social settings. The review of systems was significant for hot flashes and recent fatigue that resolved with an adjustment of her synthroid dose. Her physical examination revealed a diffuse erythema that blanched with pressure on the arms. Multiple areas of purpura, that did not blanch with pressure, were evident on her maxillary and mandibular labial and buccal mucosa. In fact, pressure on the adjacent mucosa caused additional blood filled lesions to form immediately on the labial mucosa. The patient was also noted to have 2 mm of purpura involving periorbital tissue. Antinuclear antibody, ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY April 2004 458 Abstracts