LEUKOPLAKIA

Question 1

CONCEPT

Answer 1

• CLINICAL WHITE PATCH OR PLAQUE
• CANNOT BE RUBBED OFF
• CANNOT BE CLASSIFIED UNDER ANY DISEASE
• MOST COMMON ORAL PRECANCEROUS LESION (85% OF SUCH LESIONS

Question 2

DIAGNOSIS

Answer 2

• MAY RANGE MICROSCOPICALLY FROM BENIGN HYPERKERATOSIS TO INVASIVE SQUAMOUS CELL CARCINOMA
• BIOPSY MANDATORY TO ESTABLISH A DEFINITIVE DIAGNOSIS

Question 3

ETIOLOGICAL FACTORS

Answer 3

• NO EXACT ETIOLOGICAL FACTORS
• CONTRIBUTING FACTORS: TOBACCO, ALCOHOL, CHRONIC LOCAL FRICTION, ULTRAVIOLET RADIATION, MICROORGANISMS (CANDIDA, HPV, TREPONEMA PALLADIUM)

Question 4

TARGET

Answer 4

OLDER THAN 40 YEARS/PREVALENCE INCREASES RAPIDLY WITH AGE, ESPECIALLY MALES

Question 5

ORAL LESIONS

Answer 5

• 70% LIP VERMILION, BUCCAL MUCOSA, GINGIVA
• LESIONS ON THE TONGUE/FLOOR OF THE MOUTH ACCOUNT FOR MORE THAN 90% OF THOSE THAT SHOW DYSPLASIA OR CARCINOMA

Question 6

SEVERAL CLINICAL VARIANTS

Answer 6

• HOMOGENOUS (MORE COMMON)
• GRANULAR
• SPECKLED (ERYTHROLEUKOPLAKIA)
• VERRUCOUS

Question 7

PROLEFERATIVE VERRUCOUS LEUKOPLAKIA (PVL)

Answer 7

• HIGH RISK
• PRESENT CLINICALLY: SLOWLY SPREADING, WHITE PLAQUES WITH ROUGH SURFACE PROJETCIONS
• DEVELOPS DYSPLASIA/TRANSFORMS INTO SQUAMOUS CELL CARCINOMA

Question 8

OBSERVATION

Answer 8

• 5-25% OF ORAL LEUKOPLAKIAS HAS EPITHELIAL DYSPLASIA OR CARCINOMA
• NO INVASION IN CARCINOMA IN SITU AND THERE IS NO METASTASIS WITHOUT INVASION

Question 9

MICROSCOPICALLY

Answer 9

CHANGES IN THE DYSPLASTIC EPITHELIAL CELLS ARE SIMILAR TO THE CHANGES IN SQUAMOUS CELL CARCINOMA AND MAY INCLUDE:
- ENLARGED NUCLEI AND CELLS
- INCREASED NUCLEAR-TO-CYTOPLASMIC RATIO
- HYPERCHROMATISM (EXCESSIVELY DARK-STAINING) NUCLEI
- PLEOMORPHISM (ABNORMALLY SHAPED) NUCLEI AND CELLS
- DYSKERATOSIS (PREMATURE KERATINIZATION OF CELLS)
- LARGE AND PROMIENT NUCLEOLI
- ABNORMAL MITOTIC FIGURES

Question 10

DIAGNOSIS

Answer 10

BIOPSY (NOT CLINICALLY DIAGNOSTIC): OBATIN HISTOPATHOLOGIC DIAGNOSIS AND TO GUIDE THE APPROPRIATE TREATMENT

Question 11

MILD DYSPLASIA

Answer 11

• CAN BE MONITORED OR EXCISED (DEPENDS CLINICAL JUDGMENT AND PATIENT’S BEST INTEREST)
• DIAGNOSED AS MODERATE TO SEVERE DYSPLASIA: SURGICAL EXCISION
• ELIMINATING PREDISPOSING FACTORS
• RECURRENCE: 10-35%

Question 12

RISK FACTORS

Answer 12

ASSOCIATED WITH POTENTIAL MALIGNANT TRANSFORMATION OF LEUKOPLAKIA: FEMALE GENDER, OLDER AGE, NON-SMOKING, LESION PERSISTENCE SEVERAL YEARS, EXTENSIVE LESION SIZE, INVOLVEMENT VENTROLATERAL TONGUE OF FLOOR OF MOUTH

Question 13

CONTROL

Answer 13

PERIODIC EXAMINATION (EVERY 6 MOUTHS) AND RE-BIOPSY OS NEW SUSPICIOUS AREAS OF LEUKOPLAKIA