Leukoplakia

Leukoplakia is one of the white lesions of the oral cavity in which one or more white patches or lesions forms inside the mouth. Leukoplakia is different from other causes of white patches such as candidiasis or lichen planus because it can eventually progress into oral cancer. Within 15 years, about 3% to 17.5% of people with leukoplakia will develop squamous cell carcinoma which is a common type of skin cancer. The likelihood of developing into cancer from leukoplakia depends on its size, shape, and appearance of abnormal cells.

Types Of Leukoplakia #

There are two main types of leukoplakia which are mentioned below

Homogenous #

As the name suggests homogenous means same appearance throughout the lesion i.e. mostly white, evenly colored thin patch that may have a smooth, wrinkled, or ridged surface.

Non-homogenous #

Non-homogenous is mainly white or white and red, irregularly shaped patch that may be flat, nodular which are having protrusions, or verrucous also called as elevated. The subclassifications, such as ulcerated and nodular (speckled), may also be made, and can help to predict the likelihood that a patch will become cancerous. Non-homogenous leukoplakia is seven times more likely to become cancerous than the homogenous type making it a matter of more concern than the homogenous one.

Proliferative verrucous leukoplakia (PVL) #

It is also called florid papillomatosis which is a rare but more aggressive form of oral leukoplakia. Studies have shown that it is strongly associated with the presence of Epstein-Barr virus, a type of herpes virus. Mostly all cases will eventually progress to cancer at a number of different sites. Proliferative verrucous leukoplakia is usually diagnosed at later stages in the development of leukoplakia, as it takes time to spread to multiple sites, and it also has a high rate of recurrence.

Oral hairy leukoplakia #

Oral hairy leukoplakia also occurs as a result of having the Epstein-Barr virus, which stays in the body throughout life. People with weak immune systems, having any systemic problems like people with HIV/AIDS, can develop oral hairy leukoplakia very easily. . Oral hairy leukoplakia doesn’t become cancerous but it is better to consult the doctor.

Causes #

Leukoplakia cause is often associated with the following reasons

• Excessive smoking.

• Use of tobacco or snuff like products

• Chewing areca nut which is also known as betel nut, which grows in the tropics of Asia, the Pacific, and parts of East Africa.

• Heavy consumption of alcohol.

• Few cases of leukoplakia have no known cause which is called idiopathic leukoplakia.

Most of the leukoplakia cases are seen in men who are between the ages of 50 and 70. Out of it less than 1% of cases are seen in patients under the age of 30.

Symptoms #

Most of the symptoms of leukoplakia are seen as one or more white patches on the surface of the tongue, lingual surface of the tongue, or on the lingual surfaces of the cheeks. These patches cannot be rubbed off with hands and cannot be traced to any other cause. It is not associated with any pain or other symptoms.

Some research has shown that patches on the floor of the mouth and the on the lingual surfaces of the tongue are more likely to progress into cancers. However, not all studies agree with it, and the size of a patch has no link to prove whether it can become cancerous or not.

Factors that are strong indicators of leukoplakia transforming to cancerous state include the appearance of following symmptoms

• Presence of nodules.
• White or red masses with a pebbled appearance which is the characteristic feature of leukoplakia.
• Non-healing ulceration in the affected areas.
• Increased firmness of the lesion.
• Bleeding from the site.

Diagnosis #

Since leukoplakia do not have extreme symptoms, they are often first noticed by healthcare providers only during a routine examination.

Before a diagnosis of leukoplakia is done, other possible causes of the white patches are investigated and ruled out. These could include friction inside the mouth caused due to the dentures or other prosthesis, due to repeated biting of the cheek, fungal infection like oral thrush or lichen planus.

If no cause is found after investigation for other white lesions and the white patches are not gone after two to four weeks, a biopsy i.e. tissue sample is taken and sent to the laboratory for examination to confirm the type of lesion.

Treatment #

The main goal of treating leukoplakia is to prevent it from progressing into cancer. However, treatment is a challenge and results may be mixed. Treatment may remove the lesions, but reoccurrence can be seen. The treatment of leukoplakia includes the following

Medical management #

• Stop consumption of tobacco and alcohol.
• Eat a balanced diet rich in fruits and vegetables.
• Retinoids taken by mouth may help reduce lesions, but relapses and side effects are common in this treatment.
• Vitamin A and beta-carotene supplements taken orally can help clear the white patches, but they will appear again once the person stops taking the supplements.
• Isotretinoin supplements have been found to be more effective than beta-carotene in preventing cancerous changes in leukoplakia.

Surgical management #

• Surgical management include removing lesions with surgery. However, there is still a 10% to 20% chance that the lesions will return, and a 3% to 12% chance of developing into cancer in the treated areas.
• Removal of lesions by laser can be affective.
• Photodynamic therapy in which we can see the use of light-activated cancer drugs.
• Cryotherapy in which the freezing technique is used to remove lesions.
• Electrocauterization in which the use of an electrically heated needle or other instrument to remove lesions is seen.