PANCE Blueprint EENT (6%)

Oral leukoplakia is an oral potentially malignant disorder that presents as white patches of the oral mucosa that cannot be wiped off with gauze. (compare this to oral candidiasis)

• Tobacco use (smoked and especially smokeless), alcohol abuse, HPV infections
• Leukoplakia is in itself a benign and asymptomatic condition. However, some patients will eventually develop squamous cell carcinoma (SCC)

DX: The diagnosis of leukoplakia is suspected in patients presenting with a white lesion of the oral mucosa that cannot be wiped off with gauze and that persists after eliminating potential etiologic factors, such as mechanical friction, for a six-week period

• Biopsy is indicated for any undiagnosed leukoplakia

TX: For 2–3 circumscribed lesions, surgical excision

• Destructive therapies (e.g., laser ablation, cryosurgery), medical therapies (e.g., retinoids, vitamin A, carotenoids, NSAIDs), and watchful waiting with close clinical and histologic follow-up

Oral hairy leukoplakia is a separate disorder that is not premalignant. It is an Epstein-Barr virus-induced lesion that occurs almost entirely in HIV-infected patients

• Generally affects the lateral portions of the tongue, although the floor of the mouth, the palate, or the buccal mucosa may also be involved

TX: Unlikely to progress to squamous cell carcinoma

• Treatment with zidovudine, acyclovir, ganciclovir, foscarnet, and topical podophyllin or isotretinoin
• Therapy is usually not indicated

"Thrush can be scraped off with a tongue depressor revealing inflamed mucosa underneath. Leukoplakia will remain intact when attempting to remove with a tongue depressor."