Premalignant lesions of oral cavity

Premalignant Lesions of Oral Cavity

1. Leukoplakia

Definition (WHO): A clinical white patch that cannot be characterized clinically or pathologically as any other disease.

Note: It is purely a clinical definition. It excludes other white lesions like Lichen Planus, Discoid Lupus Erythematosus, White Spongy Nevus, and Candidiasis.

A. Aetiology

  • Habits: Smoking, Tobacco chewing, Alcohol abuse (synergistic effect with smoking).
  • Trauma: Chronic trauma from ill-fitting dentures or cheek bites.
  • Associated Conditions: Submucous fibrosis, Hyperplastic candidiasis, Plummer–Vinson syndrome.

B. Epidemiology & Sites

  • Age/Sex: Mostly 4th decade; Males affected 2–3x more than females.
  • Common Sites: Buccal mucosa (Most common in India), Oral commissures.
  • Other Sites: Floor of mouth, Tongue, Gingivobuccal sulcus, Lip mucosa.

C. Clinical Types & Pathology

Type Appearance Malignant Risk
Homogenous Smooth or wrinkled white patch. Lower risk.
Nodular (Speckled) White patches/nodules on erythematous base. Higher Risk
Erosive (Erythroleukoplakia) Interspersed with erythroplakia; erosions and fissures. Higher Risk
Histology:
  • ~25% show epithelial dysplasia (mild to severe).
  • Higher grade of dysplasia = Higher chance of malignant transformation.
⚠ Malignant Potential: Ranges from 1% to 17.5% (Average 5%). Depends on site, type, and duration.

D. Management

Remove Causative Agent (Check for spontaneous regression)
↓
Biopsy (Rule out malignancy in high-risk lesions)
↓
Excision / Laser Ablation / Cryotherapy

2. Erythroplakia

Description: A red patch/plaque on the mucosal surface.

Pathophysiology: Red colour is due to decreased keratinization allowing vascular submucosa to shine through.

Clinical Features

  • Sex: No predilection.
  • Sites: Lower alveolar mucosa, Gingivobuccal sulcus, Floor of mouth.
  • Varieties:
    1. Homogenous
    2. Speckled/Granular
    3. Erythroplakia interspersed with Leukoplakia (Erythroleukoplakia).
⚠ Severe Risk: Most lesions show severe dysplasia, Ca-in-situ, or invasive carcinoma at presentation. Malignant potential is 17 times higher than Leukoplakia.

Treatment: Excision biopsy and follow-up.

3. Melanosis & Hyperpigmentation

Benign pigmented lesions may transform into Malignant Melanomas (incidence unknown).

Diagnostic Dilemma: ~25% of mucosal melanomas resemble benign lesions.
Action: Biopsy is mandatory to rule out malignancy.
📚 Source:ENT Dhingra (Chapter 44)

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