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Oral Leukoplakia

Leukoplakias Oral

Oral leukoplakia is a white patch or plaque that develops in the oral cavity and is strongly associated with tobacco smoking. More importantly, it is widely recognized as a precancerous lesion of oral squamous carcinoma. Oral leukoplakia has a wide differential diagnosis, which is why an extensive workup is necessary to rule out other etiologies.


Presentation

The definition of oral leukoplakia has undergone numerous revisions from its introduction in the medical literature. It is now defined as a white plaque that is diagnosed after excluding all other potential diagnoses that are not predisposing lesions for a malignant disease [1] [2]. The lesion is either flat or elevated, homogeneous or non-homogeneous, and often has an irregular surface and border [3]. Furthermore, non-homogeneous oral leukoplakia can be further divided into speckled, nodular (the formation of polyploids is observed) and verrucous (the most proliferative type), based on its appearance on clinical examination [3] [4]. The overall prevalence rate is estimated around 2%. Its appearance is primarily seen in adults over 40 years of age and is significantly associated with cigarette smoking [1] [2] [4] [5]. In fact, cigarette smoking was confirmed as a factor in the pathogenesis of this oral lesion after studies confirmed that cessation of smoking leads to complete resolution of oral leukoplakia [1]. Other potential risk factors include alcohol consumption and deficiency of beta-carotene, which is related to poor nutrition [3] [6]. This lesion can appear at any location within the oral cavity and its presence is much more frequently noted in males [4]. Although it is painless and may seem as a benign occurrence, many studies have reported that it has potential for malignant transformation into oral squamous carcinoma in 1-36% cases [2] [6] [7]. For this reason, early recognition is pivotal.

Disability
  • After differentiation of clinical forms of OLP (symptomatic vs asymptomatic), an impact on these patients' OHRQoL in the dimensions "physical pain" and "physical disability" was found.[ncbi.nlm.nih.gov]
Lesion of the Tongue
  • This was especially evident for lesions of the tongue when compared to the others. CONCLUSION: Angiogenesis increases during the transition from OL through dysplasia to OL-OSCC.[ncbi.nlm.nih.gov]
  • The KaplaneMeier curves for time to recurrence showed differences only for gingiva lesions compared to tongue lesions (log rank, p ¼ 0.032).[diposit.ub.edu]
  • Leukoplakia is a term used to describe white lesions on the tongue, gums, and mouth lining. Patches may also appear transparent or gray and usually have at least one area with a clear margin. Cracking may also occur.[medicalnewstoday.com]
  • […] on the tongue represented syphilitic glossitis, [28] a condition not included in the modern definitions of oral leukoplakia.[en.wikipedia.org]
Tongue Ulcer
  • Ulcerated oral leukoplakia Verrucous oral leukoplakia White sponge nevus of mucosa 528.6 Excludes Applies To Leukokeratosis of oral mucosa Leukoplakia of: gingiva lips tongue ICD-9-CM Volume 2 Index entries containing back-references to 528.6 :[icd9data.com]
Drooling
  • Drooling (Medical Encyclopedia) Gum biopsy (Medical Encyclopedia) Herpangina (Medical Encyclopedia) Leukoplakia (Medical Encyclopedia) Lichen planus (Medical Encyclopedia) Mouth sores (Medical Encyclopedia) Mouth ulcers (Medical Encyclopedia) Mucous cyst[icdlist.com]
Photosensitivity
  • The lack of long lasting photosensitization is a great advantage of ALA over all other photosensitizers.[cancerjournal.net]
  • The aim of the study is to treat patients with OL using PDT in which 5-aminolevulinic acid (ALA) is used as a photosensitizer. MATERIALS AND METHODS: Five patients with OL were included in the study.[ncbi.nlm.nih.gov]
  • The less keratinized surface and more decisive dysplasia of the latter perhaps facilitate greater penetration by photosensitizer [ 20 ].[oapublishinglondon.com]

Workup

Oral leukoplakia has a broad differential diagnosis, and the most important conditions that need to be excluded during workup are: early stages of oropharyngeal candidiasis (thrush), hairy leukoplakia (a constitutive feature of human immunodeficiency virus - HIV infection), lichen planus, lupus erythematosus, secondary syphilis, leukoedema, frictional keratosis, and aspirin burns [1] [2]. For these conditions to be excluded, a detailed patient history and a thorough physical examination of the entire body is mandatory. Physicians must inspect the entire oral cavity, particularly the sublingual region where this lesion potentially develops and is often missed. The current diagnostic criteria, in addition to clinical findings and exclusion of other potential diagnoses, rely on obtaining a biopsy sample and subsequent histopathological examination, an essential step to confirm the diagnosis [1] [2] [4]. Epithelial dysplasia, and its severity, ranging from absent (P0) to severe (P2, which may be even classified as carcinoma in situ and thus can lead to oral squamous carcinoma) determines the stage of oral leukoplakia [1] [8]. Together with the size of the lesion (the diameter of either one or multiple leukoplakias < 2cm, 2-4 cm or > 4 cm are designated as L1, L2, and L3), oral leukoplakias are staged from 1 (L1 and P0) to 4 (L3 and P1 or L of any stage and P2) [1].

Anisocytosis
  • Left: in this specimen, it can be noticed anisonucleosis, anisocytosis, nuclear and cellular pleomorphism, increased nuclear size, increased nuclear-cytoplasm ratio, and increased number and size of nucleoli of keratinocytes in an oral leukoplakia.[intechopen.com]
  • Premature keratinisation in single cells (dyskeratosis) Cytological alterations - Nuclear pleomorphism: abnormal variation in nuclear shape - Cellular pleomorphism: abnormal variation in cell shape - Anisonucleosis: abnormal variation in nuclear size - Anisocytosis[atlasgeneticsoncology.org]

Treatment

  • Complete regression was achieved in all 72 OLM lesions after a mean of 3.3 1.3 cryogun cryotherapy treatments.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis is poor for this seemingly harmless-appearing white lesion of the oral mucosa.[ncbi.nlm.nih.gov]

Etiology

  • OBJECTIVES: The study aimed to determine the proportion, known risk factors and etiology for Candida infection in leukoplakia lesions among patients with oral leukoplakia attending the Oral and Maxillofacial Clinic at a Tertiary Care Hospital in Sri Lanka[ncbi.nlm.nih.gov]
  • Therapy is usually not indicated The diagnosis of leukoplakia is suspected in patients presenting with a white lesion of the oral mucosa that cannot be wiped off with a gauze and that persists after eliminating potential etiologic factors, such as mechanical[smartypance.com]

Epidemiology

  • Our results regarding the epidemiology of OL showed a similar trend to those reported in western populations and provided preliminary epidemiological information on the Chinese population.[ncbi.nlm.nih.gov]
  • Epidemiology Frequency International OL occurs in fewer than 1% of individuals. Mortality/Morbidity OL is considered to be potentially malignant, with a transformation rate in various studies and locations that range from 0.6 to 20%.[emedicine.medscape.com]
  • Global epidemiology of areca nut usage . Addict Biol 2002; 7 : 77–83. 5. Kramer IR , Lucas RB , Pindborg JJ , Sobin LH . Definition of leukoplakia and related lesions: an aid to studies on oral precancer .[nature.com]
  • Epidemiological data show that tobacco use is related with most cases of leukoplakia. People who chew tobacco develop leukoplakia at a higher rate and usually at the exact spot where they hold the tobacco against their cheeks.[mouthandteeth.com]
  • Patient Characteristics, Medical, and Epidemiological Variables as Predictors for Cancer Table 1 summarizes patients’ demographic, medical, and epidemiological variables and their prognostic value for cancer development.[clincancerres.aacrjournals.org]
Sex distribution
Age distribution

Pathophysiology

  • Thus, idiopathic leukoplakia is considered a premalignant lesion. [1, 2] Pathophysiology The etiology of most cases of OL is unknown (idiopathic).[emedicine.medscape.com]
  • AIDS Pathophysiology AIDS Transmission AIDS Treatment AIDS Prognosis History of AIDS AIDS Stigma[news-medical.net]
  • Etiology Pathophysiology Oral mucosal lesions can appear white because of thickening of the epithelium (acanthosis), the production of excess keratin on the epithelial surface (hyperacanthosis), or accumulations of surface organisms or debris (pseudomembranes[dermatologyadvisor.com]
  • Pathophysiology [ edit ] Tumor suppressor genes [ edit ] Tumor suppressor genes are genes involved in the regulation of normal cell turnover and apoptosis (programmed cell death). [27] One of the most studied tumor suppressor genes is p53, which is found[en.wikipedia.org]

Prevention

  • OBJECTIVES: To assess the effectiveness, safety and acceptability of treatments for leukoplakia in preventing oral cancer.[ncbi.nlm.nih.gov]
  • In short, excisional biopsy of OL does not prevent malignant transformation (primary prevention), but it does promote early diagnosis of cancer (secondary prevention) and is indicated for every lesion [ 13 ].[oapublishinglondon.com]
  • Objectives: To assess the effectiveness, safety and acceptability of treatments for leukoplakia in preventing oral cancer.[cochrane.org]
  • Prevention of OHL is heavily reliant on the early diagnosis and treatment of HIV with current U.S. guidelines recommending treatment upon diagnosis.[verywell.com]

References

Article

  1. Brouns EREA, Baart JA, Bloemena E, Karagozoglu H, van der Waal I. The relevance of uniform reporting in oral leukoplakia: Definition, certainty factor and staging based on experience with 275 patients. Med Oral Patol Oral Cir Bucal. 2013;18(1):e19-e26.
  2. Van der Waal I. Oral leukoplakia, the ongoing discussion on definition and terminology. Medicina Oral, Patología Oral y Cirugía Bucal. 2015;20(6):e685-e692.
  3. Parlatescu I, Gheorghe C, Coculescu E, Tovaru S. Oral Leukoplakia – an Update. Mædica. 2014;9(1):88-93.
  4. Mutalik S, Mutalik VS, Pai KM, Naikmasur VG, Phaik KS. Oral Leukoplakia – Is Biopsy at the Initial Appointment a Must? Journal of Clinical and Diagnostic Research : JCDR. 2014;8(8):ZC04-ZC07.
  5. Petti S. Pooled estimate of world leukoplakia prevalence: a systematic review. Oral Oncol. 2003;39(8):770-780.
  6. Fan J-H, Wang J-B, Qu C-X, et al. Association between Oral Leukoplakia and Upper Gastrointestinal Cancers: A 28-year Follow-up Study in the Linxian General Population Trial. Oral Oncol. 2014;50(10):971-975.
  7. Yanik EL, Katki HA, Silverberg MJ, Manos MM, Engels EA, Chaturvedi AK. Leukoplakia, oral cavity cancer risk, and cancer survival in the U.S. elderly. Cancer Prev Res (Phila). 2015;8(9):857-863.
  8. Abe M, Yamashita S, Mori Y, et al. High-risk oral leukoplakia is associated with aberrant promoter methylation of multiple genes. BMC Cancer. 2016;16:350.

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Last updated: 2019-07-11 21:42