Can Leukoplakia Turn Into Cancer?
Yes, leukoplakia can turn into cancer. Here, we mainly consider about the oral leukoplakia and the risk of it turning into oral cancer. Leukoplakia is a pre-cancerous lesion or a potentially malignant disorder. Leukoplakia is quite common in the world population. About 2% of population has leukoplakia. 20% of leukoplakic lesions show malignancy (cancer cells) during the first recognition.
It’s important to identify the leukoplakic lesions that can turn into cancer, so that these lesions can be completely removed surgically during the initial stages. This will prevent these patients developing oral cavity cancers and dying because the cancer is not in a stage that can be operated.
Leukoplakia is Divided Into Four Types
|Leukoplakia type||Risk of malignancy|
|Early or thin||Not assigned|
|Homogenous or thick||1-7%|
|Granular or verruciform||4-15%|
|Homogenous or thick||1-7%|
Speckled or erythroleukoplakia
Leukoplakia is divided into four subtypes and the potential malignancy risk in each stage is different. The below table shows the leukoplakia type and the risk of it turning into a malignancy.
The erythroleukoplakia almost has a 50% chance of turning into cancer and it’s considered highly dangerous form of leukoplakia.
Factors That Are Considered As High Risk For Malignant (Cancer) Change:
- The verrucous type is considered highly malignant.
- If the lesion is associated with erosion or ulceration.
- Leukoplakia associated with an erythroleukoplakia (red component) has 40% risk.
- The presence of a nodule in the lesion.
- A lesion that is hard in its periphery.
- Oral leukoplakia that is seen in the floor of the mouth and undersurface of the tongue are considered highly malignant (45%).
- Elderly people (age 50-69) are at more risk of leukoplakia being malignant.
Malignancy is more seen in males. However with the increase smoking and tobacco chewing in females the malignancy risk is high in females as well.
- Development of pain or soreness in the lesion.
- Continuing tobacco chewing and smoking.
- If any of the risk factors are present these patients should be considers as high risk patients for developing cancer.
Other forms of Leukoplakia
Proliferative Verrucous Leukoplakia: It is the most aggressive form of leukoplakia. It is a multifocal patch and the surface contains projections. The lesion spreads slowly. It is seen commonly near the gums but it can be present in other areas in the oral cavity as well. One study showed that oral cavity cancer (squamous cell carcinoma) develops in 63.3% of proliferative verrucous leukoplakia and another study shows that the rate is 100%. The development of squamous cell cancer occurs usually 8 years after the initial diagnosis of proliferative verrocous leukoplakia.
Candida Leukoplakia: This is a chronic form of candida infection (fungal infection) in the oral cavity. The lesions are firm, white leathery plaques. These lesions are commonly seen on the cheeks, lips, palate and tongue. The risk of getting oral cavity cancer is 4 to 5 times more than the other forms of leukoplakia.
If you have any of the above risk factors mentioned for the leukoplakia should be removed completely. You need to undergo a very minimally invasive surgery to remove the leukoplakia.
- This can be removed either by a dentist or by an oral surgeon in the clinic under local anesthesia.
- It can be done either by using a scalpel, laser therapy or by cryotherapy (freezing the patch).
- The specimen should be sent to the lab for the pathologist see if there are any cancer cells, if cancer cells are present what type and the stage of cancer should be reported.
- Depending on the biopsy report further treatment may be needed.
- Follow-up should be done after the treatment to identify any possible recurrence.
Leukoplakia can turn into cancer, therefore you really need to be vigilant about this. There are several high risk factors for a leukoplakia to become malignant such as the verrucous type is highly malignant, erythroleukoplakia, presence of erosion, ulceration or nodule in the lesion and lesions seen in the floor of the mouth and under surface of the tongue are considered highly malignant. Proliferative verrucous leukoplakia and candida leukoplakia has a higher chance of becoming oral cavity cancer. If the above mentioned risk factors are present, it is important to completely remove the leukoplakia surgically.