Leukoplakia

This visual ‘atlas’ will help you to identify and describe non-malignant, potentially malignant and malignant oral lesions.

A diverse range of mucosal lesions can occur in the oral cavity. The history and clinical presentation of the non-malignant conditions listed below will help you differentiate them from potentially malignant or cancerous lesions. However, occasionally this can be difficult. If a lesion is suspicious, refer your patient for biopsy and definitive diagnosis.

The stage when oral cancer is diagnosed is important, as it indicates prognosis. Stage I and II oral cancer corresponds directly to size, with no evidence of metastases. Stage III and IV oral cancer has spread to the lymph nodes or distant organs. Detection of oral cancer at an early stage can save your patient’s life.

Homogenous leukoplakia

Non-homogenous leukoplakia

Verrucous leukoplakia

Nodular leukoplakia

Erythroleukoplakia

Leukoplakia are white plaques that are not caused by any other condition and which have an increased potential for malignant transformation. This is the most common potentially malignant oral mucosal condition.

Potential for malignancy has been reported to be around 1-7% for homogenous leukoplakia, and 5-50% for non-homogenous leukoplakia. While the cause is unknown, risk factors include smoking, drinking alcohol and betel quid chewing.

Diagnosis includes a biopsy for assessment of the presence of dysplasia. Management involves reducing behavioural risks, e.g. cessation of smoking and alcohol. Depending on clinical and histopathological appearance, treatment may involve excision and will require long-term monitoring of all oral mucosa.

A flat homogeneous white plaque present on the ventral surface of the left tongue, extending onto the floor of mouth. This lesion was asymptomatic and only observed on routine examination in a heavy smoker.

Last updated: March 2021