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Oral Leukoplakia

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Oral Leukoplakia, Leukoplakia, Oral White Lesion

  • See Also
  1. Oral Erythroplakia
  2. Oral Lesion
  • Definitions
  1. Oral Leukoplakia
    1. Well demarcated, white Plaque-like lesion on Oral Mucosa
  • Epidemiology
  1. Prevalence: 1 to 4% in U.S.
  2. More common in ages 40 to 70 years old
  • Risk Factors
  1. Tobacco Smoking (RR 6)
  2. Alcohol use
  • Causes
  1. General
    1. Leukoplakia is pre-cancerous (dysplasia or carcinoma in situ) or carcinoma in 10 to 46% of cases
    2. Speckled Leukoplakia (Erythroleukoplakia) is more likely to be cancer
  2. Specific Causes
    1. Leukoedema
    2. Galvanic keratosis
    3. Lichen Planus of Buccal Mucosa
    4. Verrucous carcinoma
    5. Systemic Lupus Erythematosus
    6. White sponge nevus
    7. Squamous Cell Carcinoma
  • Signs
  • Cancer-prone mucosal locations
  1. Lateral or Ventral Tongue
  2. Floor of mouth (especially near Wharton's Duct)
  3. Mandibular retromolar trigone
    1. Tonsillar Pillar and Soft Palate complex
  1. See Erythroplakia (red patches)
  2. Non-Keratotic
    1. Can scrape off with Tongue blade or gauze
    2. Causes
      1. Surface debris (food accretion)
      2. Necrosis
      3. Thrush
  3. Keratotic (cannot be rubbed off)
    1. Leukoplakia (18% of Oral Lesions)
    2. Hyperplastic Candidiasis (at lateral Tongue)
    3. Reactive hyperkeratosis (most common)
      1. Benign epithelial response
        1. Fractured tooth
        2. Dental restoration
  • Evaluation
  1. Rule out Traumatic cause
  2. Biopsy any Leukoplakia lesion that persists >2 weeks!
    1. Risk of dysplasia, carcinoma in situ or Oral Squamous Cell Carcinoma
  3. Reevaluate non-dysplastic Leukoplakia lesions every 6 months
    1. Malignant transformation may occur
  • Prevention
  1. Tobacco Cessation
  2. Alcohol cessation
  • References
  1. Randall (2022) Am Fam Physician 105(4): 369-76 [PubMed]
  2. Straub (2024) Am Fam Physician 110(5): 467-75 [PubMed]