1. Leukoplakia
BY : ZUHAIB AHMED

2. Leukoplakia
(leuko-white; plakia-patch)
 Oral leukoplakia is defined by the WHO
as “a white patch or plaque that cannot
be scrapped off and also characterized
clinically or pathologically as any other
disease”.

3. Etiology
Chemical: alcohol, tobacco
mechanical: sharp tooth or crown margins, irritating denture clasps
Premalignant epithelial changes
Candida Albicans
Ultraviolet radiation
Trauma
Toothpaste or mouth rinses (sanguinaria)

4. Etiology continued
 Acute candidiosis
 Thrush
 Acute antibiotic stomatitis
 Chronic
 Denture induced stomatitis
 Chronic hyperplasia or mucocutaneous candidiosis
 Erythematous candidiosis

5. Leukoplakia: Clinical Features
1. Affects 1.5 – 12% of total population
2. It usually affects people over the age of 40 years
(average age is 60 years).
3. Prevalence increases rapidly with age particularly in
males.
4. Approximately 8 % of the males over the age of 70
years are reportedly affected.
5. 17-25 % carcinoma in situ.
6. 5.4% may develop squamous cell carcinoma in
smokers it rises to 16%

6. Sites of predilection
 Lateral and ventral tongue
 floor of the mouth
 alveolar ridge mucosa
 corner of the mouth
 less frequently:
 soft palate
 lip

7. Site % of leukoplakia at this
site
% of leukoplakia at this
site that show dysplasia
or carcinoma
Mandibular mucosa and
sulcus
25.2 14.6
Buccal musosa 21.9 16.5
Maxillary mucosa and
sulcus
10.7 14.8
Palate 10.5 18.8
Lips 10.3 24.0
Floor of the mouth 8.6 42.9
tongue 6.8 24.2
retromolar 5.9 11.7

8. Lesions with dysplasia or
carcinoma
 None – 80%
 Mild – 12%
 severe – 5%
 Carcinoma – 3%

9. Variants
 Early or Thin Leukoplakia
 Thick Leukoplakia
 Granular Leukoplakia
 Verruciform Leukoplakia
 Proliferative Verrucous Leukoplakia

10. Clinical Forms
 Homogenous
 Non Homogenous (speckled)

11. Homogenous
 Uniform flat appearance that may exhibit
shallow cracks and has a smooth, plaque like,
wrinkled or corugated surface with a consistent
texture throughout

12. Non Homogenous
 A predominantly white or white and red lesion
(erythroleukoplakia).
 Area of redness and ulceration
 Irregularly flat, nodular thickening and
exophytic
 Nodular lesions have raised, rounded red and
or white excrescences

13. HOMOGENOUS
LEUKOPLAKIA
NONHEMOGENOUS
LEUKOPLAKIA

14. Leukoplakia: A Premalignant or
Precancerous Lesion
 Although leukoplakia is not associated with a
specific histopathologic diagnosis, it is
considered to be a premalignant lesion for the
risk of malignant transformation is greater in a
leukoplakic lesion than that associated with
normal or unaltered mucosa.

15. Malignant Transformation Potential
 Overall - 1 – 5%
 Homogenous - 0%
 Non Homogenous - 26%

16. HISTOPATHOLOGY
 Hyperkeratosis
 Acanthosis
 Atrophy
 Atypia
 Dysplasia
 Inflammation

19. Differential diagnosis
Reactive Neoplastic Infections Immune
mediated
Heriditary Idiopathic
Hyperkeratosis Epithelial
dysplasia
Chronic
hyperplastic
candidiosis
Lichen planus Leukoedema Hairy
tongue
Acanthosis Carcinoma
in situ
Hairy
leukoplakia
Lupus
erythematosus
White
sponge
nevus
Geographic
tongue
Actinic
Chelitis
Squamous
cell
carcinoma
Syphilitic
mucous
patch
Snuff dippers’s
keratosis
Verrucous
Carcinoma
Nicotine
stomatitis

20. Removable and fixed lesions
 Removable:
● Acute Pseudomembraneous Candiosis
● Chemical burns
● Plaqueand food debris
● Smoken tobacco keratosis
 Fixed
● Frictional (traumatic) keratosis
● Lichen planus
● Leukoplakia
● Smokers keratosis
● Chronic hyperplastic
● White sponge

21. Prognosis
 Most white patches are harmless. If a patch
persists, it may contain pre-cancerous or
cancerous cells. The prognosis will depend on
what type of cancer it is and whether it has
spread.

22. END