Oral Leukoplakia

• Background:

  • Oral leukoplakia (OL) is a white patch or plaque that cannot be rubbed off, cannot be characterized clinically or histologically as any other condition, and is not associated with any physical or chemical causative agent except tobacco:

    • Therefore, a process of exclusion establishes the diagnosis of the disease

• In general, the term leukoplakia implies only the clinical feature of a persistent, adherent white plaque or patch; therefore, reserve the term for idiopathic lesions when investigations fail to reveal any cause:

  • The term carries absolutely no histologic connotation, although, inevitably, some form of disturbance of the surface epithelium is characteristic

• Follow-up studies suggest that cancer is more likely to occur in individuals with idiopathic leukoplakia than in individuals who do not have this condition:

  • Thus, idiopathic leukoplakia is considered a premalignant lesion

• Pathophysiology:

  • The etiology of most cases of OL is unknown (idiopathic)

  • In other cases, the initiation of the condition may depend on extrinsic local factors and / or intrinsic predisposing factors:

    • Factors most frequently blamed for the development of idiopathic leukoplakia include:

      • Tobacco use, alcohol consumption, chronic irritation, candidiasis, vitamin deficiency, endocrine disturbances, and possibly a virus

• Epidemiology:OL occurs in fewer than 1% of individuals
  • OL is considered to be potentially malignant:With a transformation rate in various studies and locations:That range from 0.6% to 20%
  • A long-term follow-up study by Fan et al:Indicated that oral leukoplakia can increase the risk of esophageal squamous cell carcinoma
  • OL is more common in men than in women:With a male-to-female ratio of 2:1
  • Most cases of OL occur in persons in their fifth to seventh decade of life:Approximately 80% of patients are older than 40 years

• The following three stages of OL have been described:

  • The earliest lesion is nonpalpable, faintly translucent, and has white discoloration

  • Next, localized or diffuse, slightly elevated plaques with an irregular outline develop:

    • These lesions are opaque white and may have a fine, granular texture

  • In some instances, the lesions progress to thickened, white lesions, showing induration, fissuring, and ulcer formation

• Clinically, OL falls into one of the following two main groups:

  • The most common are uniformly white plaques (homogenous OL) prevalent in the buccal mucosa, which usually have low premalignant potential

  • Far more serious is speckled or verrucous leukoplakia:

    • Which has a stronger malignant potential than homogenous leukoplakia:

    • • Speckled leukoplakia consists of white flecks or fine nodules on an atrophic erythematous base

    • These lesions can be regarded as a combination of or a transition between leukoplakia and erythroplasia:

      • Which is flat or depressed below the level of the surrounding mucosal red patch, is uncommon in the mouth, and carries the highest risk of malignant transformation

Rodrigo Arrangoiz MS, MD, FACS

Here are some publications on oral cavity cancer:

• Oral Tongue Cancer: Literature Review and Current Management https://www.oatext.com/pdf/CRR-2-153.pdf
• Understand Cancer: Research and Treatment Oral Cavity Cancer: Literature Review and Current Management. https://www.researchgate.net/publication/303366031_Understand_Cancer_Research_and_Treatment_Oral_Cavity_Cancer_Literature_Review_and_Current_Management

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016