Oral Cavity Leukoplakia

Question 1

Definition of Oral Leukoplakia

Answer 1

A white patch or plaque that cannot be o/w characterized clinically.
- The diagnosis of leukoplakia will eliminate more easily recognizable conditions that include leukoedema, lichen planus, candidiasis, and white sponge nevus
- Oral leukoplakia represents the most common premalignant oral mucosal lesion; however, most cases are benign and remain so over time.

Question 2

What percentage of cases of oral leukoplakia have evidence of dysplasia?

Answer 2

1) Microscopic evidence of dysplasia is seen in 3.7% to 28.7% of cases of leukoplakia.
2) The presence of dysplasia, Carcinoma in situ, and invasive carcinoma in relation to oral cavity leukoplakia from all sites ranged from 17% to 25%.

Question 3

Why is oral leukoplakia concerning?

Answer 3

1) Oral leukoplakia is a precancerous lesion, although in the minority of cases. It is a harbinger for the development of oral cancer.
2) The presence of dysplasia, carcinoma in situ, and invasive carcinoma in relation to oral leukoplakia from all sites ranged from 17% to 25%.

Question 4

Habits/behaviors associated the presence of oral leukoplakia

Answer 4

1) Tobacco use in all of its forms
2) Betel nut use
3) Trauma
- Friction keratosis: no evidence suggests that chronic frictional trauma transforms into dysplastic or malignant disease

Question 5

What are the different types of oral leukoplakia?

Answer 5

1) Thin leukoplakia
2) Proliferative verrucous leukoplakia
- This is an aggressive form of leukoplakia - there is a greater tendency to develop SCCA (develops into SCCA in up to 74% of cases)
- Characteristically multifocal
- The floor of mouth, ventrolateral tongue, and retromolar trigone/soft palate complex carry risk levels greater than other oral sites

Question 6

Treatment of Leukoplakia

Answer 6

1) Biopsy
- With extensive lesions, multiple biopsies may be required to preclude errors of sampling
- The most suspicious parts of the leukoplakia should be included in biopsies: erythemetous, granular, ulcerated, and indurated areas should be included in any biopsies
2) Once a lesion has been defined by biopsy as benign, premalignant, or malignant, a treatment plan can be formulated:
- Benign/minimally dysplastic lesions: periodic observation or excision
- Mildly dysplastic lesions can be managed with careful f/u observation or removal if the patient is committed to this
- Premalignant lesions of moderate dysplasia or worse require removal. Removal can be accomplished with scalpel excision, laser ablation, electrocautery, or cryoablation