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, such as those emanating from the tonsils or base of tongue, 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 ...