II. Definitions

  1. Oral Leukoplakia
    1. Well demarcated, white Plaque-like lesion on Oral Mucosa

III. Epidemiology

  1. Prevalence: 1 to 4% in U.S.
  2. More common in ages 40 to 70 years old

IV. Risk Factors

V. Differential Diagnosis: White Oral Lesions

  1. Non-Keratotic
    1. Can scrape off with Tongue blade or gauze
    2. Causes
      1. Surface debris (food accretion)
      2. Necrosis
      3. Thrush
  2. Keratotic (cannot be rubbed off)
    1. Leukoplakia (18% of Oral Lesions)
    2. Hyperplastic Candidiasis (at lateral Tongue)
    3. Reactive hyperkeratosis (most common)
      1. Benign epithelial response
        1. Fractured tooth
        2. Dental restoration

VI. Causes

  1. General
    1. Leukoplakia is pre-cancerous (dysplasia or carcinoma in situ) or carcinoma in 10 to 46% of cases
    2. Speckled Leukoplakia (Erythroleukoplakia) is more likely to be cancer
  2. Specific Causes
    1. Leukoedema
    2. Galvanic keratosis
    3. Lichen Planus of Buccal Mucosa
    4. Verrucous carcinoma
    5. Systemic Lupus Erythematosus
    6. White sponge nevus
    7. Squamous Cell Carcinoma

VII. Signs: Cancer-prone mucosal locations

  1. Lateral or Ventral Tongue
  2. Floor of mouth (especially near Wharton's Duct)
  3. Mandibular retromolar trigone
    1. Tonsillar Pillar and Soft Palate complex

VIII. Evaluation

  1. Rule out Traumatic cause
  2. Biopsy any Leukoplakia lesion that persists >2 weeks!
  3. Reevaluate non-dysplastic Leukoplakia lesions every 6 months (malignant transformation may occur)

IX. Prevention

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