Leukoplakia

WHO defined leukoplakia as a clinical
white patch that cannot be characterised clinically or
pathologically as any other disease. It is a clinical definition
and does not take pathology into consideration.
Other white les ions of oral mucosa, i.e. lichen planus,
discoid lupus erythematosus, white spongy nevus and
candid iasus are excluded.
Aetiologic factors include smoking, tobacco chewing,
alcohol abuse particularly, if combined with smoking,
chronic trauma can also occur due to ill-fitting dentures
or cheek bites. It may also be associated with submucous
fibrosis, hyperplastic candidias is or Plummer-Vinson
syndrome.
Sites involved. Buccal mucosa and oral commissures are
the most common sites. It may however involve floor of
mouth, tongue, gingivobuccal sulcus and the mucosal
surface of lip. Buccal mucosa is the most common site in
India.
Age and Sex. Mostly, it is seen in the fourth decade,
males are affected two to three times more often.

Clinical types (a) Homogenous variety presents with a
smooth or wrinkled white patch. It is less often associated
with malignancy; (b) Nodular (speckled) variety
presents as white patches or nodules on erythematous
base; (c) Erosive (erythroleukoplakia) variety where leukoplakia
is interspersed with erythroplakia and has erosions
and fissures. The latter two varieties have higher incidence
of malignant transformation.
Histology. About 25% of leukoplakias may show some
form of epithelial dysplasia from mild to severe. Higher the
grade of dysplasia more are the chances of its going into
malignant change.
Malignant potential. The chances of leukoplakia
becoming malignant are cited from 1 to 17,5%. On an
average about 5% become malignant, Malignant potential
varies according to the site and type of leukoplakia,
and the duration of follow up.
Management
1, Many of the lesions will disappear spontaneously if
causative agent is removed.
2. In lesions with higher potential for malignant
change, a biopsy is taken to rule out malignancy.
3. In suspicious small lesions, surgical excision or ablation
with laser or cryotherapy can be done.