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Leukoplakia – Causes, Symptoms and Treatment

Leukoplakia refers to white patches on mucous membranes, most commonly inside the mouth. It is considered a potentially malignant lesion requiring early diagnosis and monitoring.

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Things worth knowing about "Leukoplakia"

Leukoplakia refers to white patches on mucous membranes, most commonly inside the mouth. It is considered a potentially malignant lesion requiring early diagnosis and monitoring.

What is Leukoplakia?

Leukoplakia describes white, non-removable patches or plaques that form on mucous membranes, most commonly inside the oral cavity. The term derives from the Greek words leukos (white) and plax (plate). Unlike simple oral thrush, leukoplakic lesions cannot be wiped away. Leukoplakia is classified as a potentially malignant disorder, meaning it carries a risk of transforming into oral cancer, particularly squamous cell carcinoma.

Causes and Risk Factors

While the exact cause is not always identifiable, several well-established risk factors exist:

Tobacco use: Smoking and chewing tobacco are the most common triggers.
Alcohol consumption: Regular and heavy alcohol use significantly increases risk.
Mechanical irritation: Ill-fitting dentures, sharp tooth edges, or chronic cheek biting.
HPV infection: Certain strains of Human Papillomavirus have been associated with oral leukoplakia.
UV exposure: Relevant particularly for leukoplakia of the lip mucosa.
Idiopathic leukoplakia: In some cases, no identifiable cause can be found.

Symptoms

Leukoplakia is often painless in its early stages and is frequently discovered incidentally during a dental examination. Common signs include:

White or whitish-yellow patches on the inner cheeks, tongue, gums, or floor of the mouth
Thickened or raised areas of mucosa
Mixed red-and-white lesions (known as erythroleukoplakia), which carry a higher risk of malignant transformation
Occasionally mild pain or a burning sensation

Diagnosis

Diagnosis begins with a thorough clinical inspection by a dentist or oral and maxillofacial surgeon. As similar-looking conditions must be ruled out, differential diagnosis is important:

Clinical examination: Assessment of size, shape, color, and texture of the lesion.
Biopsy: The most important diagnostic step. A tissue sample is taken and examined histologically to detect dysplasia (abnormal cell changes) or malignant cells.
Toluidine blue staining: A supplementary method used to highlight potentially suspicious areas.

WHO Classification

The World Health Organization (WHO) distinguishes between homogeneous leukoplakia (flat, uniformly white) and non-homogeneous leukoplakia (speckled, verrucous, or erosive forms), with the latter carrying a significantly higher risk of malignant transformation.

Treatment

Treatment depends on the severity, location, and presence of dysplasia:

Elimination of risk factors: Quitting tobacco and reducing alcohol intake are the most important steps and may lead to spontaneous regression of lesions.
Surgical removal: Lesions with dysplasia or unclear pathology are removed surgically, via laser therapy, or cryotherapy.
Regular follow-up: Even after removal, close monitoring is necessary due to the risk of recurrence.
Pharmacological approaches: Retinoids (Vitamin A derivatives) have been studied but are not standard treatment due to limited efficacy and side effects.

Prognosis and Malignant Transformation Risk

The overall risk of malignant transformation is approximately 1–2% per year. Non-homogeneous lesions with severe dysplasia carry a considerably higher risk. Early detection and treatment significantly improve prognosis. Regular dental check-ups are therefore strongly recommended for individuals with known risk factors.

References

Warnakulasuriya S. et al. - Nomenclature and classification of potentially malignant disorders of the oral mucosa. Journal of Oral Pathology and Medicine, 2007.
World Health Organization (WHO) - Classification of Tumours: Pathology and Genetics of Head and Neck Tumours. IARC Press, 2017.
Bagan J. et al. - Oral leukoplakia: Clinical, histopathologic, and molecular aspects. Oral Diseases, 2019.

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