LEUKOPLAKIA
SYNOPSIS
● INTRODUCTION
● ETIOLOGY
● CLASSIFICATION
● PATHOPHYSIOLO
GY
● CLINICAL
FEATURES
● DIAGNOSIS
● TREATMENT
● PROGNOSIS K
INTRODUCTION :
( LEUKO - WHITE ; PLAKIA -
PATCH )
● Oral leukoplakia is defined by the WHO as “ a
white patch or plaque that cannot be
characterised clinically or pathologically as any
other disease”.
● As with most oral white lesions,the clinical colour
results from a thickened surface keratin layer ,
which appears white when wet or a thickened
spinous layer,which makes the normal
vascularity ( redness ) of the underlying connective
INCIDENCE AND
PREVALENCE :
● Affects 1.5 % - 12 % of total population.
● The onset usually takes place after 30
years : resulting in peak incidence above
the age of 50 years.
● Prevalence is usually higher in males.
● 4 % of malignant transformation.
ETIOLOGY
● Chemical : Alcohol,Tobacco.
● Mechanical : Sharp tooth or crown margins ,
irritating denture clasps.
● Premalignant epithelial changes.
● Candida Albicans.
● Ultra-violet radiation.
● Trauma.
● Toothpaste or mouth rinses ( sanguinaria )
SITES OF PREDILECTION
● Lateral and ventral tongue.
● Floor of the mouth.
● Alveolar ridge mucosa.
● Corner of the mouth.
● Less frequently ; soft palate
and lip
CLINICAL FORMS
1. Homogeneous - lesions that are uniformly white.
2. Non - homogeneous - lesions in which part is white
and part is red.
3. Proliferative verrucous leukoplakia.
4. Erythroleukoplakia.
5. Sublingual keratosis.
6. Oral hairy leukoplakia.
7. Syphilitic leukoplakia.
HOMOGENOUS
• Uniform flat appearance that may exhibit shallow
cracks and has a small , plaque like , wrinkled or
corrugated surface with a consistent texture
throughout.
• IMAGE : A diffuse , corrugated white patch on the
right ventral surface of the tongue and floor of the
NON - HOMOGENOUS
• Non – homogenous leukoplakia is a lesion of non – uniform
appearance. The colour may be predominantly white or a
mixed white and red. The surface is irregular and may be
flat ( popular ) , nodular or exophytic.
• IMAGE : Exophytic leukoplakia on the buccal mucosa.
GRANULAR LEUKOPLAKIA
• Most thick , smooth lesions remain indefinitely at this
stage. Some perhaps as many as one third , regress or
disappear ; a few become even more severe , develop
increased surface irregularities.
• IMAGE : Focal leukoplakic lesion with a rough granular
surface on the posterior lateral border of the tongue .
PROLIFERATIVE VERRUCOUS LEUKOPLAKIA
• A special high risk form of leukoplakia and is characterised
by the development of multiple keratotic plaque with
roughened surface projections.
• It is usually uncommon and involves the buccal mucosa
and the gingiva.
ERYTHROLEUKOPLAKIA
• Erythroleukoplakia is a non homogenous lesion of mixed
white
( keratotic ) and red ( atrophic ) colour .
• Erythroplakia is an entirely red patch that cannot be
attributed to any other cause.
• Erythroplakia can therefore be considered a variant of
either leukoplakia or erythroplakia since its appearance is
midway between.
ORAL HAIRY LEUKOPLAKIA
• Oral hairy leukoplakia is a corrugated white lesion on the
other side of the tongue caused by opportunistic infection
with EBV on a systemic background of immunodeficiency
almost always HIV.
• The condition is not considered to be a true idiopathic
leukolplakia since the causative agent has been identified.
HISTOLOGIC APPEARANCE
• Leukoplakia has a wide range of possible appearance.
• The degree of hyperkeratosis,epithelial
thickness,dysplasia and inflammatory cell infiltration in the
underlying lamina propria are variable.
• The following are commonly cited are being possible
features of epithelial dysplasia in leukoplakia specimens ;
1. Cellular pleomorphism.
2. Nuclear atypia.
3. Increased number of cells seen undergoing mitosis , including both normal and
abnormal mitoses.
4. Abnormal keratinization.
DIAGNOSIS
• The clinician should first try to rule out any of the defin
