Dr. Rupak Sethuraman
SPECIFIC LEARNING OBJECTIVES
 To learn the common white lesions of the oral mucosa.
 To learn the etiopathogenesis, clinical features,
investigations and treatment for oral leukoplakia.
FORMAT
 Some common white lesions of the oral cavity
 Etiopathogenesis of oral leukoplakia
 Investigations and treatment for leukoplakia
COMMON WHITE LESIONS
 Leukoedema
 Linea Alba Buccalis
 Chemical injuries of the oral mucosa
 Candidiasis
 Oral Leukoplakia
 Oral Submucous fibrosis
 Oral Lichen Planus
Leukoplakia
(leuko-white; plakia-patch)
 Oral leukoplakia is defined by the WHO as “a
white patch or plaque that cannot be
characterized clinically or pathologically as any
other disease”.
 Thus a diagnosis by exclusion.
 The term is strictly a CLINICAL one and does not
imply a specific histopathologic tissue alteration.
 Leukoplakia is the most common oral precancer.
Leukoplakia: Why is it White?
 The clinical color (white) results from a thickened
surface keratin layer (which appears white when wet)
and/or a thickened spinous layer, which masks the
normal vascularity (redness) of the underlying
connective tissue.
Leukoplakia: A Premalignant or
Precancerous Lesion
 Although leukoplakia is not associated with a specific
histopathologic diagnosis, it is considered to be a
premalignant lesion for the risk of malignant
transformation is greater in a leukoplakic lesion than
that associated with normal or unaltered mucosa.
 Despite the fact that leukoplakia is a premalignant
lesion it should be noted that not every lesion shows
histopathologic evidence of epithelial dysplasia or
frank malignancy (squamous cell carcinoma).
 In fact, dysplastic epithelium or invasive carcinoma is
found in only 5 to 25 % of the biopsy samples of
leukoplakia.
Leukoplakia: Malignant Transformation
Potential
 Overall, the malignant transformation potential of
leukoplakia is 4 % (estimated lifetime risk).
 However, specific clinical subtypes are associated with
much higher potential malignant transformation rates
(as high as 47 %).
Etiology of Leukoplakia: The Role of
Tobacco
 The habit of tobacco smoking appears most closely
associated with leukoplakia development.
 80 % of patients with leukoplakia are smokers.
 Smokers are much more likely to have leukoplakia
than non-smokers.
 Heavier smokers have greater numbers of and larger lesions
than light smokers.
 A large proportion of leukoplakias in persons who stop
smoking either disappear or become smaller soon after
discontinuing the habit.
 Candida albicans has been demonstrated histologically
in the hyperplastic/dysplastic epithelium of lesions
termed candidal leukoplakia and candidal hyperplasia.
 Human papillomavirus (HPV), particularly subtypes 16
and 18, have been identified in some oral leukoplakias.
Leukoplakia: Clinical Features
 Leukoplakia usually affects people over the age of 40
years (average age is 60 years).
 Prevalence increases rapidly with age particularly in
males.
 Approximately 8 % of the males over the age of 70
years are reportedly affected.
 Approximately 70 % of the oral leukoplakias are found
on the lip vermilion, buccal mucosa and gingiva.
Leukoplakia: Clinical Features
Continued
 Early/mild thin leukoplakia, which seldom shows
dysplasia on biopsy, may disappear or continue
unchanged.
 If the cause (s) of the lesion are not removed, many
lesions will gradually become thicker and larger.
INVESTIGATIONS
 Toluidine blue staining followed by biopsy to look for
dysplastic features.
Leukoplakia: Treatment and Prognosis
 Treatment depends upon the diagnosis and any
leukoplakia exhibiting moderate epithelial
dysplasia or worse warrants complete removal if
possible.
 Treatment of lesions exhibiting less severe changes
is guided by the size of the lesion and its response
to more conservative measures such as eliminating
tobacco use.
VARIOUS TREATMENT
MODALITIES
1. Carotenoids- Antioxidant action
 Beta Carotene 20-90mg/day for 3-12 months
 Lycopene
4-8 mg/day for 3 months
2. Vitamins
Vitamin A, E and C
3. Topical Bleomycin 0.5% per day for 12-15 days or
1% per day for 14 days
4. Photodynamic Therapy
Leukoplakia: Treatment and Prognosis
Continued
 Leukoplakia not exhibiting dysplasia often is not
excised but clinical evaluation every 6 months is
recommended.
 Additional biopsies are recommended if smoking
continues or if clinical changes increase in severity.
 Thank you
 Any questions???