Overview

Leukoplakia is a condition characterized by the formation of thick, white or gray patches inside the mouth, on the tongue, or on the inner cheeks. These patches cannot be scraped off and are usually painless. Leukoplakia itself is not cancerous, but it is considered a precancerous lesion, meaning there is a risk that these patches can develop into oral cancer over time, especially if left untreated. It is most commonly seen in adults and is often linked to chronic irritation from tobacco use, alcohol consumption, or other irritants. Early detection and management are important to prevent progression to more serious conditions.

Causes

The exact cause of leukoplakia is not always clear, but it is mainly associated with repeated irritation or trauma to the mucous membranes of the mouth. Common causes and risk factors include:

• Tobacco use: Smoking cigarettes, cigars, pipes, or using smokeless tobacco (chewing tobacco) is the most significant risk factor.
• Alcohol consumption: Heavy drinking, especially in combination with tobacco use, increases the risk of leukoplakia.
• Chronic irritation: Poorly fitting dentures, rough teeth, or frequent cheek or tongue biting can cause constant irritation.
• Human papillomavirus (HPV): Certain strains of HPV, particularly HPV-16, are associated with an increased risk of oral lesions.
• Inflammatory conditions: Ongoing inflammation from infections or autoimmune conditions can contribute to the formation of leukoplakia.

Symptoms

Leukoplakia usually develops slowly and may go unnoticed in its early stages. Common symptoms and signs include:

• White or gray patches: Thick, slightly raised patches on the tongue, inner cheeks, gums, or roof of the mouth.
• Firm or rough texture: The patches may feel rough, firm, or leathery to the touch.
• Painless lesions: Most cases are painless, although some individuals may feel mild irritation or sensitivity.
• Red areas (erythroleukoplakia): In some cases, red patches appear alongside the white patches, which carry a higher risk of cancerous changes.
• Changes in size or appearance: Patches that increase in size, become hardened, or develop irregular borders should be evaluated promptly.

Diagnosis

Diagnosing leukoplakia involves a combination of clinical evaluation and diagnostic tests to rule out other conditions and assess cancer risk:

• Oral examination: A healthcare provider will visually inspect the mouth and feel for abnormal areas.
• Medical history: Discussion of tobacco, alcohol use, dental history, and any previous oral lesions.
• Exfoliative cytology: Scraping cells from the lesion to examine under a microscope.
• Biopsy: A small sample of tissue is taken for histopathological examination to determine if precancerous or cancerous changes are present.
• HPV testing: In some cases, testing for HPV infection may be done to assess additional cancer risk factors.

Treatment

Treatment of leukoplakia focuses on eliminating the source of irritation and monitoring or removing the lesions to prevent progression to cancer:

• Lifestyle changes:
  • Complete cessation of tobacco use.
  • Reducing or eliminating alcohol consumption.
  • Improving oral hygiene and addressing dental issues like ill-fitting dentures.
• Medical monitoring: Regular follow-up visits to monitor the lesion for any changes in size, color, or texture.
• Surgical removal:
  • If lesions are large, display dysplasia (precancerous changes), or do not regress after eliminating irritants, surgical excision may be recommended.
  • Methods include scalpel excision, laser therapy, or cryotherapy (freezing).
• Medications: In some cases, topical treatments or systemic medications such as retinoids may be prescribed to reduce lesion size.

Prognosis

The prognosis for leukoplakia depends on various factors, including the presence of dysplasia, lesion size, and adherence to treatment recommendations. In many cases, especially when caught early and the irritant is removed, leukoplakia can resolve without complications. However, there is a risk of malignant transformation, particularly in high-risk cases like erythroleukoplakia or lesions with severe dysplasia.

With proper treatment and regular monitoring, the risk of progression to oral cancer can be significantly reduced. Early detection remains crucial, and individuals with a history of leukoplakia should undergo regular dental and medical check-ups to monitor for recurrence or new lesions.