Leukoplakia, Erythroplakia, Oral Lichen Planus, & Oral Cancer

Key Features

Essentials of Diagnosis

LEUKOPLAKIA

• A white lesion that cannot be removed by rubbing the mucosal surface

HAIRY LEUKOPLAKIA

• Found in patients with HIV infection

• Occurs on lateral border of tongue

• Develops quickly

• Appears as slightly raised leukoplakic areas with corrugated surface

ERYTHROPLAKIA

• Similar to leukoplakia except that it has a definite erythematous component

ORAL LICHEN PLANUS

• Most commonly presents as lacy leukoplakia but may be erosive

• Definitive diagnosis requires biopsy

ORAL CANCER

• Early lesions appear as leukoplakia or erythroplakia

• More advanced lesions are larger, with invasion into tongue producing a palpable mass lesion; ulceration may be present

OROPHARYNX CANCER

• Unilateral throat masses, typically presenting with painful swallowing and weight loss

General Considerations

LEUKOPLAKIA

• About 2–6% represent either dysplasia or early invasive squamous cell carcinoma (SCC)

• Histologically, there is often hyperkeratoses, occurring in response to chronic irritation

HAIRY LEUKOPLAKIA

• Seen in about 19% of HIV-positive patients with oral lesions

• Can occur following solid organ transplantation

• Associated with Epstein-Barr virus infection and long-term systemic corticosteroid use

ERYTHROPLAKIA

• About 90% of cases are either dysplasia or carcinoma, so distinction from leukoplakia is important

ORAL LICHEN PLANUS

• An inflammatory pruritic disease of the skin and mucous membranes

• Mucosal lichen planus must be differentiated from leukoplakia

• Erosive oral lesions require biopsy and often direct immunofluorescence for diagnosis because lichen planus may simulate other erosive diseases

• There is a low risk (1%) of SCC arising within lichen planus

ORAL CANCER

• Alcohol and tobacco use are the major etiologic risk factors

OROPHARYNX CANCER

• Generally presents later than oral cavity squamous cell carcinoma

• Typically associated with known carcinogens such as tobacco and alcohol

• The human papillomavirus (HPV)—most commonly, type 16—is believed to cause up to 70% of oropharyngeal squamous cell carcinoma cases

• HPV-related tumors often present in advanced stages of the disease with regional cervical lymph node metastases (stages III and IV) but have a better prognosis than similarly staged lesions in tobacco and alcohol users

Clinical Findings

Symptoms and Signs

• Intraoral examination (lateral tongue, floor of the mouth, gingiva, buccal area, palate, and tonsillar fossae) and palpation of the neck for enlarged lymph nodes in patients over age 45 who smoke tobacco or drink immoderately

LEUKOPLAKIA

• Any white lesion that cannot be removed ...