Grading & Level of Importance: B
White adherent mucosal changes, reflecting increased or abnormal keratinisation of the stratified squamous (normally not keratinised) mucosal epithelium of the mouth or transitional epithelium (lips, penis).
Aetiology & Pathogenesis
Based on cause. Exogenous: chemical (tobacco) or mechanical irritation (abnormal teeth, dentures), also hereditary.
Signs & Symptoms
Asymptomatic white plaques.
Anywhere in the mouth, especially buccal or sublingual mucosa; also genital or anal mucosa.
Laboratory & other workups
Epithelial hyperplasia with or without atypia.
Chronic, can evolve into carcinoma.
Clinical features; if persistent or infiltrated histology is mandatory.
Candidiasis (thrush), lichen planus, squamous cell carcinoma.
Prevention & Therapy
Clinical follow-up, eliminating irritating factors, in some instances oral retinoids or excision.
- Statement 1 Every leukokeratotic lesion of the oral cavity which cannot be easily removed with a tongue blade must be biopsied
- This 30-year-old man consults you for intensely pruritic papules on the flexor surface of the wrist and on the ankle. At the same time, you find these white lesions in his mouth. Your diagnosis?
- A 32-year-old women with multiple substance abuse problems consults you about white lesions on the side of her tongue that she can't brush off. What disease should you suspect?
- This 60 year old man has a squamous cell carcinoma in situ of the tongue. He has a 40 pack-year smoking history. The lesion must be excised. What procedure is needed to complete the diagnostic process?
- Statement 1 Oral leukoplakia must always be biopsied
- 65-year-old man with alcohol and nicotine abuse has had dentures for 10 years. What are the differential diagnostic considerations for the lesion shown?
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