Leukoplakia: White Oral Lesion, Precancerous Potential, and Management

Leukoplakia = a white plaque on oral mucosa (tongue, buccal mucosa, floor of mouth, gingiva) that cannot be scraped off and cannot be classified as any other definable lesion.

Key Features

• Precancerous: 1–18% malignant transformation (higher with dysplasia, non-homogeneous, floor of mouth/tongue, size >2 cm).
• Risk factors: Tobacco (smoked/smokeless), alcohol, betel nut, chronic irritation (sharp teeth, dentures), HPV, immunosuppression.
• Clinical types: Homogeneous (flat, uniform) vs. Non-homogeneous (speckled, nodular, verrucous – higher risk).

Diagnosis & Management

1. Biopsy (incisional) for histopathology (dysplasia grading).
2. Eliminate risk factors (tobacco/alcohol cessation).
3. Treat local irritants (dental).
4. Surveillance: q3–6mo if no/mild dysplasia; excision/laser for moderate/severe dysplasia or high-risk features.
5. Follow-up lifelong (field cancerization).

Erythroplakia (red patch) carries even higher malignant potential (~90%).