Leukoplakia is a white plaque that does not rub off and cannot be clinically identified as another entity. Most of the leukoplakia results form a chronic irritation to the oral cavity.
Leukoplakia is defined as a “potentially malignant disorder.” The word potentially malignant disorder according to WHO means risk of malignancy being present in a lesion or condition either during the time of initial diagnosis or at a future date.
Is Leukoplakia Malignant?
Leukoplakia is not a malignancy, but it is a pre-malignant condition or a potential malignant disorder. A 20% of leukoplakic lesions show evidence of cancer at the first recognition. It is one of the most common premalignant condition and the prevalence rate of leukoplakia in the world is about 2%. Most of the cancers develop from a potential malignant disorder.
It is advised to take a biopsy of any oral cavity lesion that persists for more than 14 days after the chronic irritation is removed. Just by seeing the lesion we cannot tell whether it’s a benign lesion or a cancer. An excisional biopsy is best because that will remove the whole lesion and the pathologist will have the whole lesion to identify any cancer cells. Oral brush biopsy only takes some parts of the lesion and the cancer cells may not be present in that specimen sample. Then the cancer will be missed out and it will be hard to cure the cancer when the patient present at a late stage.
Leukoplakia Is Divided Into Four Types
- Early or thin
- Homogenous or thick
- Granular or verruciform
- Speckled or erythroleukoplakia
- Each subtype has a different malignant potential.
Risk of Malignancy in Each Subtype
- Early or thin – not assigned
- Homogenous or thick – 1-7%
- Granular or verruciform – 4-15%
- Speckled or erythroleukoplakia – 18-47%
- 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 increased smoking and tobacco chewing in females, the malignancy risk is high in females as well who smoke and chew tobacco.
Development of pain or soreness in the lesion.
Continuing tobacco chewing and smoking.
In studies done on oral leukoplakia, it is found that there is a higher chance of oral cavity cancers in people who has oral leukoplakia. If the oral leukoplakia is removed completely at the initial stages the risk of getting oral cancers reduce significantly. Studies also suggest to use oral leukoplakia as a screening test to identify oral cavity cancers early. This can reduce the deaths that occur from oral cavity cancers.
It is important to identify the patients with high risk of getting a malignancy from the oral leukoplakia and treating them early. If you are at high risk of getting oral cancer it’s important you quit smoking, tobacco chewing and fix any other irritation that can cause leukoplakia. Then you need to get the proper medical treatment and follow up afterwards regularly to check if the cancer is still present or completely cured.
Conclusion
Oral leukoplakia is a premalignant or a potential malignant disorder. It is not a malignancy. Oral leukoplakia is quite commonly seen in the world population. Nearly 20% of the lesions show cancer cells at the first recognition. 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. Elderly males who are continuing tobacco chewing, smoking also increase the risk of leukoplakia turning into a malignancy.
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