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Leukoplakia

Leukoplakia
Other namesLeucoplakia,[1] leukokeratosis,[1] idiopathic leukoplakia,[2] leukoplasia,[1] idiopathic keratosis,[3] idiopathic white patch[3]
Leukoplakia on the inside of the cheek
SpecialtyOral and maxillofacial surgery, Oral medicine, Dentistry
SymptomsFirmly attached white patch on a mucous membrane, changes with time[4][5][6]
ComplicationsSquamous cell carcinoma[4]
Usual onsetAfter 30 years old[4]
CausesUnknown[6]
Risk factorsSmoking, chewing tobacco, excessive alcohol, betel nuts[4][7]
Diagnostic methodMade after other possible causes ruled out, tissue biopsy[6]
Differential diagnosisYeast infection, lichen planus, keratosis due to repeated minor trauma[4]
TreatmentClose follow up, stop smoking, limit alcohol, surgical removal[4]
FrequencyUp to 8% of men over 70[6]

Oral leukoplakia is a potentially malignant disorder affecting the oral mucosa. It is defined as "essentially an oral mucosal white lesion that cannot be considered as any other definable lesion." Oral leukoplakia is a white patch or plaque that develops in the oral cavity and is strongly associated with smoking.[8] Leukoplakia is a firmly attached white patch on a mucous membrane which is associated with increased risk of cancer.[4][5] The edges of the lesion are typically abrupt and the lesion changes with time.[4][6] Advanced forms may develop red patches.[6] There are generally no other symptoms.[9] It usually occurs within the mouth, although sometimes mucosa in other parts of the gastrointestinal tract, urinary tract, or genitals may be affected.[10][11][12]

The cause of leukoplakia is unknown.[6] Risk factors for formation inside the mouth include smoking, chewing tobacco, excessive alcohol, and use of betel nuts.[4][7] One specific type is common in HIV/AIDS.[13] It is a precancerous lesion, a tissue alteration in which cancer is more likely to develop.[4] The chance of cancer formation depends on the type, with between 3–15% of localized leukoplakia and 70–100% of proliferative leukoplakia developing into squamous cell carcinoma.[4]

Leukoplakia is a descriptive term that should only be applied after other possible causes are ruled out.[6] Tissue biopsy generally shows increased keratin build up with or without abnormal cells, but is not diagnostic.[4][6] Other conditions that can appear similar include yeast infections, lichen planus, and keratosis due to repeated minor trauma.[4] The lesions from a yeast infection can typically be rubbed off while those of leukoplakia cannot.[4][14]

Treatment recommendations depend on features of the lesion.[4] If abnormal cells are present or the lesion is small surgical removal is often recommended; otherwise close follow up at three to six month intervals may be sufficient.[4] People are generally advised to stop smoking and limit the drinking of alcohol.[3] In potentially half of cases leukoplakia will shrink with stopping smoking;[5] however, if smoking is continued up to 66% of cases will become more white and thick.[6] The percentage of people affected is estimated at 1–3%.[4] Leukoplakia becomes more common with age, typically not occurring until after 30.[4] Rates may be as high as 8% in men over the age of 70.[6]

  1. ^ a b c Cite error: The named reference Nev2002 was invoked but never defined (see the help page).
  2. ^ Cite error: The named reference Gli2003 was invoked but never defined (see the help page).
  3. ^ a b c Odell W (2010). Clinical problem solving in dentistry (3rd ed.). Edinburgh: Churchill Livingstone. pp. 209–217. ISBN 978-0-443-06784-6. Archived from the original on 2017-09-10.
  4. ^ a b c d e f g h i j k l m n o p q r Villa A, Woo SB (April 2017). "Leukoplakia-A Diagnostic and Management Algorithm". Journal of Oral and Maxillofacial Surgery. 75 (4): 723–734. doi:10.1016/j.joms.2016.10.012. PMID 27865803.
  5. ^ a b c Scully C, Porter S (July 2000). "ABC of oral health. Swellings and red, white, and pigmented lesions". BMJ. 321 (7255): 225–8. doi:10.1136/bmj.321.7255.225. PMC 1118223. PMID 10903660.
  6. ^ a b c d e f g h i j k Neville BW, Damm DD, Chi AC, Allen CM (2015). Oral and Maxillofacial Pathology (4 ed.). Elsevier Health Sciences. pp. 355–358. ISBN 9781455770526.
  7. ^ a b Underner M, Perriot J, Peiffer G (January 2012). "[Smokeless tobacco]". Presse Médicale. 41 (1): 3–9. doi:10.1016/j.lpm.2011.06.005. PMID 21840161. S2CID 206741213.
  8. ^ Mohammed F, Fairozekhan AT (2022). "Oral Leukoplakia". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 28723042. Retrieved 16 January 2022.
  9. ^ Lodi G, Franchini R, Warnakulasuriya S, Varoni EM, Sardella A, Kerr AR, Carrassi A, MacDonald LC, Worthington HV (July 2016). "Interventions for treating oral leukoplakia to prevent oral cancer". The Cochrane Database of Systematic Reviews. 2016 (7): CD001829. doi:10.1002/14651858.CD001829.pub4. PMC 6457856. PMID 27471845.
  10. ^ Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA (2011). Campbell-Walsh Urology: Expert Consult Premium Edition: Enhanced Online Features and Print, 4-Volume Set. Elsevier Health Sciences. p. 2309. ISBN 9781416069119.
  11. ^ Banfalvi G (2013). Homeostasis - Tumor - Metastasis. Springer Science & Business Media. p. 156. ISBN 9789400773356.
  12. ^ Montgomery EA, Voltaggio L (2012). Biopsy Interpretation of the Gastrointestinal Tract Mucosa: Volume 1: Non-Neoplastic (2 ed.). Lippincott Williams & Wilkins. p. 10. ISBN 9781451180589.
  13. ^ Coogan MM, Greenspan J, Challacombe SJ (September 2005). "Oral lesions in infection with human immunodeficiency virus". Bulletin of the World Health Organization. 83 (9): 700–6. hdl:10665/269477. PMC 2626330. PMID 16211162.
  14. ^ Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C (September 2005). "The global burden of oral diseases and risks to oral health". Bulletin of the World Health Organization. 83 (9): 661–9. hdl:10665/269475. PMC 2626328. PMID 16211157.

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