Oral leukoplakia is a white patch or plaque of the oral mucosa that cannot be characterized clinically or pathologically as any other disease.
The classical presentation is a thickened mucosa, over the gums, inside the cheeks, bottom of the mouth and, sometimes, the tongue. These patches can't be scraped off. All forms of leukoplakia are more often seen in older individuals.
All lesions should be palpated to evaluate for firmness or induration, which may indicate the presence of an invasive carcinoma; the sites with the highest incidence of development of squamous cell carcinoma are the ventral tongue, floor of mouth, buccal mucosa, and gingiva; although the soft palate is an uncommon site for leukoplakia, it has a high prevalence of dysplasia or carcinoma when it does occur.
Leukoplakia may appear as:
Tobacco use, particularly smokeless tobacco, puts the patient at high risk of leukoplakia and oral cancer. Long-term alcohol use increases the risk, and drinking alcohol combined with smoking increases the risk even more.
The histological characteristics of leukoplakia are:
There is no curative treatment for leukoplakias. Multiple therapies have been tried for temporary control of the disease, including surgical excision, carbon dioxide (CO2) and laser ablation, cryotherapy, radiation therapy, photodynamic therapy, topical bleomycin, and oral retinoids. Nevertheless, more than 70 percent of patients experience recurrence and/or progression to carcinoma despite interventions.
Patients with leukoplakia require lifelong close clinical and histopathologic monitoring for the development of malignancies. Lesions that show suspicious changes, such as increased heterogeneity, ulcerated areas, hardening of involved mucosa, and lymphadenopathy, should be biopsied for histopathologic examination.