Leukoplakia

Leukoplakia:

Def: A predominantly white lesion of the oral mucosa that cannot be characterized as any other definable lesion.

Examples White lesions : candidal leukoplakia, Hairy leukoplakia, tobacco induced lesion,  Idiopathic leukoplakia.

Age/gender: Above 30 yrs of age, occurs more in males.

Etiology:

• Betel Quid
• Alcohol
• Physical irritants
• Candida albicans – candidial leukoplakia shows more chances of malignant transformation.

Clinical features:

Homogenous: Lesions that are uniformly white, they are 3 types – smooth, furrowed, Ulcerated. Usually asymptomatic

Non Homogenous: Part of the lesion is white and the rest appears reddened, well demarcated white areas, interspread with reddened areas. Associated with mild complaints of Localized pain or discomfort. It can also be called Erythro leukoplakia or Speckled Leukoplakia, and Verrucous Leukoplakia also comes under this.

Histopathological Features: Presence or absence of Epithelial Dysplasia. Epithelial Hyperplasia, Surface hyperkeratosis.

Epithelial Dysplasia:

Features of Dysplasia:

• Loss of polarity of the basal cells
• Presence of more than one layer of cells having a basaloid appearance
• increased nuclear cytoplasmic ratio
• Drop shaped rete processes
• Irregular epithelial stratification
• Increased mitotic figures
• Presence of mitotic figures in superficial half of the epithelium
• Cellular pleomorphism
• Enlarged nuclei
• Reduction in cellular cohesion
• Keratinisation of cells

Grading of leukoplakia based on its size and presence or absence of dysplasia:

It is divided into 4 Stages: called OLEP staging system

Stage I: size- <2cm, No dysplasia

Stage II: size 2-4cm, No dysplasia

Stage III: size >4cm, No dysplasia, or size 2-4cm with dysplasia

Stage IV: Size >4cm with dysplasia

Diagnostic Procedures:

1) Eliminate the other possible white lesions

2) Biopsy:

• For homogenous – to knw the extent of dysplastic changes.
• For Non Homogenous: Should be taken only at the site of symptoms, redness or induration
• Should be done if the treatment procedure includes CO2-laser evaporation

3) Toulidine Blue staining or lugols iodine

4) Exfoliative Cytology

Treatment Modalities:

Observation for 1-2 weeks after elimination of suspected irritants

• Surgical Excision
• Cryosurgery
• CO2-laser surgery
• Retinoids and other drugs
• Photodynamic therapy