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Leukoplakia (AKA White Patch)
Definition
The term leukoplakia (Greek, “white patch”) is defined by
the World Health Organisation as "a white plaque /
patch, firmly attached to the oral mucosa, that cannot be
rubbed off or clinically identified as another named
entity". It is therefore strictly a clinical label rather than a
histological diagnosis.
Leukoplakias should be biopsied, after which a more
definitive diagnosis can be assigned. Most prove to be
benign (usually hyperkeratosis or chronic inflammation),
however, up to 20% may exhibit histological changes
consistent with dysplasia or carcinoma. They should
therefore be regarded with suspicion until proven
otherwise, particularly if occurring in a high-risk site such as
the ventral or lateral tongue or floor of mouth.
The clinical appearance is extremely variable with respect
to size, shape, thickness, and homogeneity of colour. They
are usually asymptomatic.
Ætiology
The exact ætiology remains unknown. Tobacco, alcohol,
chronic local friction, betel use; sanguinarine use and
Candida albicans are important predisposing factors.
Others include Epstein Bar Virus and Syphilis. These
latter carry a higher risk of malignant transformation.
Clinical Features
Occurs in approx 1% of the population; men > women
Three clinical varieties are recognised:
Definition
The term leukoplakia (Greek, “white patch”) is defined by
the World Health Organisation as "a white plaque /
patch, firmly attached to the oral mucosa, that cannot be
rubbed off or clinically identified as another named
entity". It is therefore strictly a clinical label rather than a
histological diagnosis.
Leukoplakias should be biopsied, after which a more
definitive diagnosis can be assigned. Most prove to be
benign (usually hyperkeratosis or chronic inflammation),
however, up to 20% may exhibit histological changes
consistent with dysplasia or carcinoma. They should
therefore be regarded with suspicion until proven
otherwise, particularly if occurring in a high-risk site such as
the ventral or lateral tongue or floor of mouth.
The clinical appearance is extremely variable with respect
to size, shape, thickness, and homogeneity of colour. They
are usually asymptomatic.
Ætiology
The exact ætiology remains unknown. Tobacco, alcohol,
chronic local friction, betel use; sanguinarine use and
Candida albicans are important predisposing factors.
Others include Epstein Bar Virus and Syphilis. These
latter carry a higher risk of malignant transformation.
Clinical Features
Occurs in approx 1% of the population; men > women
Three clinical varieties are recognised:
- homogeneous (common; faintly white – very thick &
opaque) - speckled (less common; non-homogenous /
heterogenous leukoplakias has a high risk of
malignant transformation) and - verrucous (rare).
| Management of Leukoplakia |
Useful Websites:
New Zealand Dermatological Society (DermNZ)
Emedicine (Dermatology)
Wikipedia
Patient UK
NHS Clinical Knowledge Summaries
NHS Choices
CancerHelp UK
Bond's Book of Oral Diseases, 4th Edition
International Agency for Research on Cancer / World Health
Organisation
Emedicine (Oral Medicine)
Dermatology Online Journal
Mayo Clinic
Medscape News Today
Useful Articles:
Leukoplakia - Clinician Information Sheet. Eastman Dental Institute
Oral Medicine Clinic
Journal of Dental Education 2002. Systematic Review of
Randomized Trials for the Treatment of Oral Leukoplakia
CA Cancer J Clin 2002. Oral Cancer and Precancerous Lesions
Critical Reviews in Oral Biology & Medicine 2003. Prognosis of Oral
Pre-malignant Lesions - Significance of Clinical, Histopathological &
Molecular Biological Characteristics
Oral Oncology 2005. Long-term treatment outcome of oral
pre-malignant lesions
Cochrane Review 2008. Interventions for treating Oral Leukoplakia
MJA 2009. Clinical Update. Oral White Lesions - Pitfalls of
Diagnosis
Head Neck 2009. Treatment & Follow-up of Oral Dysplasia - A
Systematic Review & Meta-Analysis
New Zealand Dermatological Society (DermNZ)
Emedicine (Dermatology)
Wikipedia
Patient UK
NHS Clinical Knowledge Summaries
NHS Choices
CancerHelp UK
Bond's Book of Oral Diseases, 4th Edition
International Agency for Research on Cancer / World Health
Organisation
Emedicine (Oral Medicine)
Dermatology Online Journal
Mayo Clinic
Medscape News Today
Useful Articles:
Leukoplakia - Clinician Information Sheet. Eastman Dental Institute
Oral Medicine Clinic
Journal of Dental Education 2002. Systematic Review of
Randomized Trials for the Treatment of Oral Leukoplakia
CA Cancer J Clin 2002. Oral Cancer and Precancerous Lesions
Critical Reviews in Oral Biology & Medicine 2003. Prognosis of Oral
Pre-malignant Lesions - Significance of Clinical, Histopathological &
Molecular Biological Characteristics
Oral Oncology 2005. Long-term treatment outcome of oral
pre-malignant lesions
Cochrane Review 2008. Interventions for treating Oral Leukoplakia
MJA 2009. Clinical Update. Oral White Lesions - Pitfalls of
Diagnosis
Head Neck 2009. Treatment & Follow-up of Oral Dysplasia - A
Systematic Review & Meta-Analysis
| Photo of an Oral Leukoplakia |
| Photo of a Speckled Oral Leukoplakia |
| Photo of a Verrucous Oral Leukoplakia |
Speckled and verrucous leukoplakias have a greater risk
for malignant transformation than the homogeneous form.
The average percentage of malignant transformation for
leukoplakia varies between 4% and 6%.
The buccal mucosæ, tongue, floor of the mouth, gingivæ
and lower lip are the most commonly affected sites.
However, leukoplakias found in the soft palate complex,
on ventro-lateral aspects of the tongue & the floor of
mouth have a high risk of malignant transformation.
The malignant potential depends on appearance, site &
some ætiological factors.
Laboratory Tests
Histo-pathological examination.
Differential Diagnosis
The following conditions should be considered before
making a diagnosis of leukoplakia:
Treatment
for malignant transformation than the homogeneous form.
The average percentage of malignant transformation for
leukoplakia varies between 4% and 6%.
The buccal mucosæ, tongue, floor of the mouth, gingivæ
and lower lip are the most commonly affected sites.
However, leukoplakias found in the soft palate complex,
on ventro-lateral aspects of the tongue & the floor of
mouth have a high risk of malignant transformation.
The malignant potential depends on appearance, site &
some ætiological factors.
Laboratory Tests
Histo-pathological examination.
Differential Diagnosis
The following conditions should be considered before
making a diagnosis of leukoplakia:
- Lichen Planus
- Cinnamon Contact Stomatitis
- Candidiasis
- Hairy Leukoplakia
- Lichenoid reactions
- Chronic biting
- Smokers Keratosis
- Leukœdema
- Chemical burn (such as Aspirin)
- Uræmic Stomatitis
- Skin graft and
- Discoid Lupus Erythematosus.
Treatment
- Elimination or discontinuation of pre-disposing factors
(such as tobacco or betel nut) - Surgical excision is the treatment of choice
- Medical treatment entails the use of anti-
inflammatories or anti-fungals; topical anti-cancer
drugs or retinoid compounds. These cause
regression of the leukoplakias but their efficacy is
temporary. - Chemo-prevention, which prevents leukoplakias from
becoming malignant, entail the use of retinoids (such
as 13-cis-retinoic acid and fenretinide). However,
problems with side-effects, lack of availability and
recurrence limits their use. - Lesions removed followed by regular follow-ups.
| Last Updated 4th November 2011 |