PANCE Blueprint EENT (7%)

Patient will present as → a 42-year-old male with symptoms of the flu. On social history, the patient describes drinking 2-3 beers per day as well as smoking 1 pack of cigarettes per day. He is noted on physical exam to have a white plaque-like lesion on the side of the tongue which could not be scraped off with a tongue depressor.

Oral leukoplakia is an oral potentially malignant disorder that presents as white patches of the oral mucosa that cannot be wiped off with a 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, about 5% will eventually develop squamous cell carcinoma (SCC)
• If there is an associated erythematous appearance (erythroplakia), there is a higher risk of dysplasia or cancer (90%)

*A separate disorder that is not premalignant is oral hairy leukoplakia, an Epstein-Barr virus-induced lesion that occurs almost entirely in HIV-infected patients

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

• Excisional biopsy is indicated for any undiagnosed leukoplakia

leukoplakia - all should be treated

• For 2–3 circumscribed lesions, surgical excision
• For multiple or large lesions where surgery would cause unacceptable deformity, consider cryosurgery, or laser surgery
• Removal of predisposing habits (alcohol and tobacco)
• Complete excision is the standard treatment for dysplasia or malignancy
• After treatment, up to 30% of leukoplakia recurs, and some leukoplakia still transforms to squamous cell carcinoma

Oral Hairy Leukoplakia is unlikely to progress to squamous cell carcinoma

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