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:

      • It 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