Oral Leukoplakia
Related Subjects:
|Macroglossia
|Microstomia
|Glossitis
|Medical Teeth
|Gum hypertrophy
|Angular Stomatitis - Cheilitis
|Oral Aphthous Ulcers
|Oral Leukoplakia
ℹ️ About
- Oral Leukoplakia is defined as a white patch in the oral cavity that cannot be rubbed off and cannot be clinically or pathologically attributed to another disease.
- It is a potentially premalignant lesion with a variable risk of transformation to oral squamous cell carcinoma (OSCC).
- Requires referral to Oral Medicine / Maxillofacial specialists for biopsy and risk stratification.
Aetiology & Risk Factors
- Exact pathogenesis uncertain; represents epithelial dysplasia due to chronic irritation or carcinogen exposure.
- Tobacco use (smoked and smokeless) and alcohol are the strongest associations.
- Chronic mechanical trauma (ill-fitting dentures, sharp teeth).
- Viral: HPV and EBV implicated in subsets.
- More common in men (2:1), usually >50 yrs, but may occur earlier in immunocompromised (HIV+).
Clinical Features 🩺
- White, well-demarcated patch or plaque, often on the tongue, buccal mucosa, or gingiva.
- Cannot be scraped off (distinguishes from candidiasis).
- Painless in early stages; late signs may include induration, ulceration, or discomfort.
- Check for cervical lymphadenopathy → raises suspicion for malignancy.
Differential Diagnoses ⚖️
- Oral candidiasis (can be scraped off).
- Hairy leukoplakia (HIV+, lateral tongue, EBV-driven).
- Lichen planus (lacy/reticular striations, chronic inflammation).
- Squamous cell carcinoma (ulcerated, indurated lesion).
- Syphilitic mucous patches (secondary syphilis).
- Aphthous ulcers (painful, self-limiting).
Features Suggesting Higher Malignant Potential 🚨
- Non-homogeneous: verrucous, speckled (red and white), ulcerated.
- Induration or nodularity on palpation.
- Lesions on floor of mouth, undersurface of tongue, or soft palate.
- Size > 200 mm² or persistent/progressive lesions.
Investigations 🔎
- Incisional biopsy is essential → histopathological assessment of epithelial dysplasia.
- Histological grading: mild → moderate → severe dysplasia → carcinoma in situ → invasive SCC.
- Adjuncts: toluidine blue staining, brush cytology, autofluorescence (specialist setting).
Management 💊
- Lifestyle modification: Stop smoking, reduce alcohol, improve oral hygiene.
- Specialist referral: All leukoplakia should be evaluated by Oral Medicine / Maxillofacial team.
- Surgical excision / laser ablation: Indicated for lesions with moderate–severe dysplasia, high-risk sites, or malignant transformation.
- Close surveillance: Low-grade lesions may be observed with 3–6 monthly reviews.
- Adjuncts: Beta-carotene, retinoids studied but evidence limited.
- Key Point: Recurrence common → long-term follow-up is mandatory.
Prognosis 📊
- Overall malignant transformation risk: ~1–20% depending on lesion site, size, and histology.
- High-risk areas: floor of mouth > tongue undersurface > soft palate.
- Homogeneous leukoplakia has lower risk, non-homogeneous (erythroleukoplakia/verrucous) much higher risk.
