Know Your Leukoplakias to Identify Oral Cancer
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Leukoplakias may all be white patches, but that does not mean all leukoplakias are alike! Lesions may vary in thickness, ranging from thin and homogenous to thick and irregular. As a general rule, thinner leukoplakias are more likely to be benign or have only mild dysplasia, while lesions that are thicker may have higher degrees of dysplasia. This is not always the case, however, and biopsy is required to definitively exclude premalignant or malignant changes. In some cases, leukoplakic lesions may appear “speckled,” meaning that they have both red and white areas. These speckled leukoplakias are also referred to as erythroleukoplakias, and they often show dysplasia or invasive cancer on biopsy.

here are some helpful things to look out for:

-The lateral aspects of the tongue and floor of the mouth are the high-risk sites for developing oral cancer. Even if a lesion occurring at these sites appears clinically innocuous, it should be viewed with a higher degree of suspicion.

-Leukoplakias of the occlusal plane on an edentulous ridge often (but not always) represent examples of frictional keratosis secondary to the forces of mastication and food or other irritants rubbing against the area. These are less clinically concerning, especially if they are present bilaterally.

-Placing appropriate weight on the patient’s stated social history. A lack of tobacco and alcohol consumption does not necessarily make a leukoplakia less suspicious. Conversely, not all leukoplakias in patients with a history of smoking and drinking will be premalignant or malignant. Similarly, patients may overstate (or understate) the degree of local irritation (such as tongue biting) to a site, especially if asked leading questions.

-Symptoms can be misleading! Lesions that are painful are not always bad, and asymptomatic leukoplakias will not always be innocuous.

-Texture plays an important role in the evaluation of a lesion. Firm or indurated lesions often are clinically worrisome and may be more likely to show epithelial dysplasia or invasive carcinoma.

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