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
Question 1 |
palate Hint: See C for explanation. | |
floor of the mouth Hint: See C for explanation. | |
lateral tongue | |
gingiva Hint: See C for explanation. |
Question 2 |
Oral cancer | |
Oral candidiasis Hint: Oral candidiasis presents with white patches. Unlike leukoplakia, the patches easily rub off. | |
Aphthous ulcer Hint: While aphthous ulcers are commonly found on the buccal mucosa, they are usually 1 to 2 mm round ulcerative lesions. | |
Necrotizing ulcerative gingivitis Hint: Necrotizing ulcerative gingivitis is common in young adults under stress. Clinically, it presents with painful acute gingival inflammation and necrosis. |
List |
References: Merck Manual · UpToDate