Leukoplakia: Description, Causes and Risk Factors:
Leukoplakia is the most common precancerous lesion. The term leukoplakia simply means a “white patch”, and it has been
used in a sense to describe any white lesion in the mouth. This non-specific usage led to confusion among physician, surgeons and researchers who attributed a precancerous nature to many innocuous lesions. Some investigators tried, although unsuccessfully, to restrict this term only to those white lesions that histologically indicated epithelial dysplasia. Since the mid-1960s there has been a considerable understanding and clarification in the concept of leukoplakia, and now leukoplakia is recognized as a specific entity.
Types may include:
- Hookli associated
- Mishri associated
- Khaini associated
- Leukoplakia associated with betel quid chewing.
About 32% of the of the nodular leukoplakias are infected by Candida albicans organism as compared by Candida albicans organism as compared to the 18% of the homogeneous and 5% of the ulcerated leukoplakias. The exact relationship between the presence of candidal hyphae on epithelial dysplasia and the natural history of leukoplakia is not clearly understood.
Hairy leukoplakia is caused by the infection of Epstein -Barr virus (EBV). This virus can attack during childhood. The virus remains inactive in the body without showing any symptoms of it presence. The studies show that this virus remains in the body for the entire life of a person. This virus is inactive and dormant most of the years, but once the immune system of the body becomes weak, the virus gets activated and attacks the person. This leads to hairy leukoplakia.
Most cases of leukoplakia are found in older men, but women can develop this problem as well. The condition is very uncommon in people under 40 years of age, however, it has been seen in these individuals as well.
There is strong evidence that both oral cancer and oral leukoplakia can be induced and promoted by tobacco.
- The proportion of tobacco users (both smoking and smokeless tobacco) among individuals with leukoplakia is high, and a relationship is evident between the tobacco habit and the anatomical location of the leukoplakia.
- Cross-sectional studies show a higher prevalence of is among smokers than among nonsmokers.
- A dose-response relationship exists between tobacco use and oral it.
- Intervention studies show a regression of oral leukoplakia after tobacco cessation.
According to well-documented epidemiologic data from different countries over the last thirty years, the prevalence of oral leukoplakia varies between 1.1 to 11.7 percent with a mean value of 2.9 percent.
While most cases of leukoplakia are cured once they are removed, it has been well documented that about one in three lesions will grow back. The chance of the leukoplakia returning is increased for those patients who continue smoking. For this reason, we always recommend periodic re-evaluation of the oral mucosa by someone who is familiar with the lining of the mouth. If the leukoplakia should recur, repeat biopsy is generally advisable.
Usually, it affects the tongue and inner part of the cheeks.
- Usually, the lesion is white or gray in color.
- It looks thick, hard, and slightly raised.
- The white patch of leukoplakia develops gradually over two to four weeks. The lesion may turn rough and hard, and it becomes sensitive to temperature, touch, and spicy foods.
The clinical diagnosis of it ismade by listening to the patient's medicaland social history, looking carefully at thelining of the mouth, and by excluding otherpossible causes of white patches in themouth. Often a biopsy is needed.
In most cases, a biopsy will determine how advanced the leukoplakia is in terms of its precancerous potential. Sometimes the changes in the lining of the mouth seen under the microscope are very subtle, and this is sometimes called “epithelial atypia.” The significance of this is unknown. While it is unlikely that “epithelial atypia” will soon become cancerous, we cannot rule out the possibility of this happening sometime in the future. If the changes seen are more suggestive that the lining of the mouth will probably become cancer, this is called “epithelial dysplasia”, and it is usually graded as mild, moderate or severe, depending on what the tissue looks like under the microscope. In a small percentage of cases, the very beginning stages of oral cancer may be seen.
The type of treatment that is recommended will depend on several things, including the location in the mouth of the leukoplakia, how large the leukoplakia is, how “bad” the dysplasia appears under the microscope, and the patient's age, habits, and other medical problems. For leukoplakias diagnosed as “atypia” or “mild dysplasia” in an older adult who smokes, we usually recommend that the patient stop smoking, and the lining of the mouth should be re-evaluated periodically. For those leukoplakias diagnosed as “moderate” or “severe”, we usually recommend complete removal of the white patch in order to prevent the development of oral cancer. Removal can be done by traditional scalpel excision, electrocautery, liquid nitrogen application or laser surgery. Each treatment has its advantages and disadvantages, and deciding which one should be used depends on each patient's situation.
Although a number of surgical and medicinal approaches of it, there medicinal appear to be of it, there does not approaches any universally adopted, successful treatment. In recent years with a newer retinoids (vitamin A analogues) is being tried. The preliminary results in terms of remission of lesions are encouraging.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.