Professional Documents
Culture Documents
BY : Vincy Varghese,
Anubhav Agrawal
514
SYNOPSIS
• Introduction
• Etiology
• Classification
• Pathophysiology
• Clinical Features
• Diagnosis
• Treatment
• Prognosis
LEUKOPLAKIA
(LEUKO-WHITE; PLAKIA-PATCH)
• Oral leukoplakia is defined by the WHO as “a white patch or plaque that cannot be scrapped
off and also characterized clinically or pathologically as any other disease”.
• Candida Albicans
• Ultraviolet radiation
• Trauma
• Homogenous Leukoplakia
• Non Homogenous Leukoplakia
• Proliferative verrucous leukoplakia
• Erythroleukoplakia
• Sublingual keratosis
• Oral hairy leukoplakia
• Syphilitic leukoplakia
HOMOGENOUS
• Tumor suppressor genes are genes involved in the regulation of normal cell turnover
and apoptosis (programmed cell death). One of the most studied tumor suppressor
genes is p53, which is found on the short arm of chromosome 17. Mutation of p53
can disrupt its regulatory function and lead to uncontrolled cell growth.
• Mutations of p53 have been demonstrated in the cells from areas of some
leukoplakias, especially those with dysplasia and in individuals who smoke and
drink heavily.
CLINICAL SIGNIFICANCE
• Leukoplakia is marked by unusual-looking patches inside mouth. They may be
sensitive to touch, heat, spicy foods, or other irritation. These patches can vary
in appearance and may have the following features:
• white or gray color
• thick, hard, raised surface
• hairy (hairy leukoplakia only)
• red spots (rare)
The patches may take several weeks to develop, and they’re rarely painful.
Some women may develop leukoplakia on the outside of their genitals in the
vulva area.
HISTOLOGIC APPEARANCE
Leukoplakia has a wide range of possible histologic appearances. The degree of hyperkeratosis,
epithelial thickness (acanthosis/atrophy), dysplasia and inflammatory cell infiltration in the
underlying lamina propria are variable.The following are commonly cited as being possible
features of epithelial dysplasia in leukoplakia specimens:
• Cellular pleomorphism
• Nuclear atypia
• Increased number of cells seen undergoing mitosis, including both normal and abnormal
mitoses.
• The distinction between the epithelial layers may be lost.
• Abnormal keratinization
• Alteration of the normal epithelial-connective tissue architecture - the rete pegs may become
"drop shaped". wider at their base than more superficially.
DIAGNOSIS
• Leukoplakia is usually diagnosed with an oral exam. During a physical exam, dentist or primary
care doctor can confirm if the patches are leukoplakia. One might mistake the condition for oral
thrush. Thrush is a yeast infection of the mouth. The patches it causes are usually softer than
leukoplakia patches. They may bleed more easily.
• Dentist or doctor may need to do other tests to confirm the cause of spots. This helps suggesting
a treatment that may prevent future patches from developing.
• If a patch looks suspicious, dentist or doctor will do a biopsy. To do a biopsy, they remove a small
piece of tissue from one or more of spots. They then send that tissue sample to a pathologist for
diagnosis. The goal is to look for signs of oral cancer.
BIOPSY
• Tissue biopsy is usually indicated to rule out
other causes of white patches and also to enable
a detailed histologic examination to grade the
presence of any epithelial dysplasia. This is an
indicator of malignant potential and usually
determines the management and recall interval.
The sites of a leukoplakia lesion that are
preferentially biopsied are the areas that show
induration (hardening) and erythroplasia
(redness), and erosive or ulcerated areas. These
Microscopic examination of
areas are more likely to show any dysplasia keratinocytes scraped from
than homogenous white areas. the buccal mucosa
TREATMENT
• Most patches improve on their own and don’t require any treatment. It’s important to avoid
any trigger that may have caused your leukoplakia, such as tobacco use. If it’s related to
irritation from a dental problem, dentist may be able to address this.
• If a biopsy comes back positive for oral cancer, the patch must be removed immediately.
This can help prevent the spread of the cancer.
• Small patches can be removed by a more extensive biopsy using laser therapy or a scalpel.
Large leukoplakia patches require oral surgery.
• Hairy leukoplakia may not require removal. dentist or doctor might prescribe antiviral
medications to help stop the patches from growing. Topical ointments containing retinoic
acid can also be used to reduce patch size.
HOW CAN LEUKOPLAKIA BE PREVENTED?
• The annual malignant transformation rate of leukoplakia rarely exceeds 1%, i.e. the
vast majority of oral leukoplakia lesions will remain benign.
• A number of clinical and histopathologic features are associated with varying
degrees of increased risk of malignant transformation, although other sources argue
that there are no universally accepted and validated factors which can reliably
predict malignant change.
• It is also unpredictable to an extent if an area of leukoplakia will disappear, shrink
or remain stable.