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ABSTRACT
Despite recent advances in therapy and treatment for oral cancer, survival rates are still low. It is generally accepted that oral
cancer may arise from potentially premalignant disorders. Oral erythroplakia has been identified as the one with the highest
malignant transformation rates. The aim of this review was to provide detailed information on oral cancer and oral
erythroplakia. Few data are available on oral erythroplakia and there is an urgent need for randomized controlled trials.
Early detection and diagnosis is still the key to survival rates. Dentists and physicians may play an important role in the
detection of premalignant lesions and therefore improve patients’ outcome.
Keywords: Erythroplakia, oral cancer, malignant.
Abbreviations and acronyms: ENT = ear, nose and throat; HNSCC = head and neck squamous cell carcinoma; SCC = squamous cell
carcinoma.
(Accepted for publication 17 November 2010.)
together with leukoplakia (erythroleukoplakia); it pre- (0.21%), while Lumerman21 reported the lowest
dominately occurs in the floor of the mouth, the soft (0.01%) (Table 1).
palate, the ventral tongue and the tonsillar fauces. Erythroplakia was identified through a clinical oral
There are usually no symptoms. However, some examination and biopsy. Sixty-two lesions developed
patients may complain of a burning sensation and ⁄ or oral cancer with a malignant transformation rate of
sore. Erythroplakia shows dysplastic features and often 44.9%. However, this is just an estimate of the
presents as ‘carcinoma in situ’ or ‘invasive carcinoma’ progression rate because of the differences across the
at the time of biopsy.17–19 Heavy alcohol consumption studies and because risky behaviours (e.g. tobacco
and tobacco use are known to be important aetiological smoking, alcohol consumption) were not considered in
factors. Surgical excision is the treatment of choice the majority of the studies. Interestingly, most of the
though more studies are needed.15,16 The differential studies were hospital based, thus the real prevalence
diagnosis includes: erythematous candidiasis, early may differ. As such, there is an urgent need for large
SCC, local irritation, mucositis, lichen planus, lupus population based studies with an active follow-up.
erythematosous, drug reaction and median rhomboid
glossitis.20
Implications for clinicians
The epithelium is often atrophic and shows lack of
keratin. Sometimes hyperplasia is seen. The red colour Dentists, ear, nose and throat (ENT) specialists or oral
is due to the epithelial thinness that allows the surgeons may be the first to find a red patch in the
underlying microvasculature to show through. mouth of their patients. Unless a lesion has features
mandating immediate biopsy, oral health professionals
should eliminate the potential causes (such as minimiz-
Oral erythroplakia and progression to cancer
ing frictional sources) and re-evaluate the patient in 10
Using PubMed, Cochrane Library and Medline to 14 days.22 If the lesion is still present, biopsy and
throughout June 2010, we conducted a search of the referral to an oral medicine specialist are needed. Areas
medical literature for articles on oral erythroplakia. The of chronic inflammation and traumatic lesions usually
key search terms used were ‘oral erythroplakia’. Case resolve or reduce in size within two weeks. On the
reports were not included for the purpose of this contrary, any persistent mucosal lesion should be
analysis. The search identified 211 potentially eligible considered suspicious for oral cancer. A thorough
studies. After examining the abstract and full text of the initial evaluation of symptoms and signs is essential,
articles, 10 papers were considered relevant. Papers together with a biopsy and long-term follow-up. Early
were considered relevant if they reported on prevalence detection of such lesions may prevent malignant
data or information on the malignant progression to transformation.23 Therefore, it is important to improve
invasive cancer. the ability of general dental practitioners to detect any
Oral erythroplakia lesions were examined in 10 relevant lesions at the earliest stage in order to interrupt
studies carried out from 1971 to 2007. The largest the chain of progression to cancer. Indeed, general
studies were carried out in the United States and India. dental practitioners may be the first to see such lesions
The total number of subjects was 226 534 and 258 oral and therefore they should be able to recognize them and
potentially malignant lesions were identified. The mean institute appropriate treatment such as biopsy or early
prevalence of oral erythroplakia was 0.11%. Hashibe15 referral. Also, clinicians may focus on educating their
reported the highest prevalence of erythroplakia patients about oral cancer risk factors, in addition to
changing risk behaviours.24 Finally, an increase in 18. Lapthanasupkul P, Poomsawat S, Punyasingh J. A clinicopatho-
logic study of oral leukoplakia and erythroplakia in a Thai pop-
public awareness about the importance of regular oral ulation. Quintessence Int 2007;38:e448–455.
screening may have the potential to reduce the burden
19. Shafer WG, Waldron CA. Erythroplakia of the oral cavity.
of oral cancer.25,26 Cancer 1975;36:1021–1028.
20. Sciubba JJ. Oral cancer. The importance of early diagnosis and
treatment. Am J Clin Dermatol 2001;2:239–251.
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