LEUKOPLAKIA

BY : ZUHAIB AHMED

Leukoplakia(leuko-white; plakia-

patch)

Oral leukoplakia is defined by the WHO as “a white patch or plaque that cannot be scrapped off and

also characterized clinically or pathologically as any other

disease”.

EtiologyEtiology

Chemical: alcohol, tobacco

mechanical: sharp tooth or crown margins, irritating denture clasps

Premalignant epithelial changes

Candida Albicans

Ultraviolet radiation

Trauma

Toothpaste or mouth rinses (sanguinaria)

Chemical: alcohol, tobacco

mechanical: sharp tooth or crown margins, irritating denture clasps

Premalignant epithelial changes

Candida Albicans

Ultraviolet radiation

Trauma

Toothpaste or mouth rinses (sanguinaria)

Etiology continued

Acute candidiosis Thrush Acute antibiotic stomatitis

Chronic Denture induced stomatitis Chronic hyperplasia or mucocutaneous

candidiosis Erythematous candidiosis

Leukoplakia: Clinical Features

1. Affects 1.5 – 12% of total population2. It usually affects people over the age of

40 years (average age is 60 years).3. Prevalence increases rapidly with age

particularly in males.4. Approximately 8 % of the males over the

age of 70 years are reportedly affected.5. 17-25 % carcinoma in situ.6. 5.4% may develop squamous cell

carcinoma in smokers it rises to 16%

Sites of predilectionSites of predilection

Lateral and ventral tongue floor of the mouth alveolar ridge mucosa corner of the mouth less frequently:

soft palate lip

Lateral and ventral tongue floor of the mouth alveolar ridge mucosa corner of the mouth less frequently:

soft palate lip

Site % of leukoplakia at this site

% of leukoplakia at this site that show dysplasia or carcinoma

Mandibular mucosa and sulcus

25.2 14.6

Buccal musosa 21.9 16.5

Maxillary mucosa and sulcus

10.7 14.8

Palate 10.5 18.8

Lips 10.3 24.0

Floor of the mouth 8.6 42.9

tongue 6.8 24.2

retromolar 5.9 11.7

Lesions with dysplasia or carcinoma

None – 80%

Mild – 12%

severe – 5%

Carcinoma – 3%

Variants

Early or Thin Leukoplakia Thick Leukoplakia Granular Leukoplakia Verruciform Leukoplakia Proliferative Verrucous Leukoplakia

Clinical Forms

Homogenous

Non Homogenous (speckled)

Homogenous

Uniform flat appearance that may exhibit shallow cracks and has a smooth, plaque like, wrinkled or corugated surface with a consistent texture throughout

Non Homogenous

A predominantly white or white and red lesion (erythroleukoplakia).

Area of redness and ulceration Irregularly flat, nodular thickening and

exophytic Nodular lesions have raised, rounded red

and or white excrescences

HOMOGENOUS LEUKOPLAKIA

NONHEMOGENOUS LEUKOPLAKIA

Leukoplakia: A Premalignant or Precancerous Lesion

Although leukoplakia is not associated with a specific histopathologic diagnosis, it is considered to be a premalignant lesion for the risk of malignant transformation is greater in a leukoplakic lesion than that associated with normal or unaltered mucosa.

Malignant Transformation Potential

Overall - 1 – 5%

Homogenous - 0%

Non Homogenous - 26%

HISTOPATHOLOGY

Hyperkeratosis Acanthosis Atrophy Atypia Dysplasia Inflammation

DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSISReactive Neoplasti

cInfections Immune

mediatedHeriditary Idiopath

ic

Hyperkeratosis Epithelial dysplasia

Chronic hyperplastic candidiosis

Lichen planus

Leukoedema

Hairy tongue

Acanthosis Carcinoma in situ

Hairy leukoplakia

Lupus erythematosus

White sponge nevus

Geographic tongue

Actinic Chelitis

Squamous cell carcinoma

Syphilitic mucous patch

Snuff dippers’s keratosis

Verrucous Carcinoma

Nicotine stomatitis

Removable and fixed lesions Removable:

Acute Pseudomembraneous Candiosis Chemical burns Plaqueand food debris Smoken tobacco keratosis

Fixed Frictional (traumatic) keratosis Lichen planus Leukoplakia Smokers keratosis Chronic hyperplastic White sponge

Prognosis

Most white patches are harmless. If a patch persists, it may contain pre-cancerous or cancerous cells. The prognosis will depend on what type of cancer it is and whether it has spread.

END