Erythroplakia

Erythroplakia: Rare condition which is most likely to develop into a malignancy, as it is associated with histologic premalignant changes.

Def: Lesions of the oral mucosa that present as bright red velvety plaques which cannot be characterized clinically or pathologically as any other condition.

Synonyms:

• Erythroplasia
• Erythroplasia of Queyrat

Almost all true erythroplakias demonstrate significant epithelial dysplasia, carcinoma in situ, or invasive squamous cell carcinoma.

Prevalence Rate of Erythroplakia is estimated as 1 per 2500 adults.

It has more prevalence in Males > Females

Erythroplakia may also occur in conjunction with leukoplakia and has been found concurrently with a large population of early invasive oral carcinomas

Etiology:

• Mostly unknown
• But suspected to be same as those associated with invasive squamous cell carcinoma of the mouth.

Conditions which resemble Erythroplakia:

• Nonspecific Mucositis
• Dermatoses
• Stomatitis associated with dentures
• Ttuberculosis
• Psoriasis
• Vascular Lesions

Clinical Features:

• Erythroplakia is seen mostly in Older Men – 65 to 74 years of age.
• Common Sites: Floor of the mouth, Tongue and soft palate
• Mucosa appears to be well demarcated erythematous macule or plaque with a soft, velvety texture
• Assymptomatic and when associated with adjacent Leukoplakia – Erythroleukoplakia

Types:

• Homogenous Erythroplakia
• Erythroplakia interspread with patches of Leukoplakia
• Granular or Speckled leukoplakia

80-90% Erythroplakia cases  histopathologically are either severe epithelial Dysplasia, Carcinoma in Situ or invasive Carcinoma

No Sex differentiation

Unknown Etiology and seems alcohol abuse and smoking are important etiological factors.

Histopathological Features:

Lack of keratin production by epithelium and is Atrophic, but maybe Hyperplastic. Lack of keratin n thin epithelium shows the underlying microvasculature causing the red colour.

Connective tissue shows chronic inflammation

To Demonstrate Erythroplakia from other conditions 1% Toulidine Blue solution is applied, which helps to detect epithelial dysplasia.

Treatment:

• Observation for 1-2 weeks after elimination of suspected irritants
• Lesions exhibiting moderate dysplasia or worse must be removed completely or destroyed by the methods used for leukoplakia
• Biopsy to be done if the lesion still persists.
• Surgical Excision gives excellent prognosis
• Rucurrence and multifocal oral mucosal involvement are common with erythroplakia, hence long term follow-up is suggested for treatment of patients