eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Leukoplakia, Oral: Differential Diagnoses & Workup

Author: Crispian Scully, MD, PhD, DSc, FRCPath, MRCS, CBE, MDS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FMedSci, FHEA, FUCL,DSc, DChD, DMed(HC), Dr hc., Professor, Director of Special Projects, Eastman Dental Institute for Oral Health Care Sciences; Professor, Special Needs Dentistry, University College; Professor, Oral Medicine, Pathology and Microbiology, University of London
Contributor Information and Disclosures

Updated: Oct 17, 2008

Differential Diagnoses

Burns, Chemical
Lichen Planus

Other Problems to Be Considered

Drug abuse

Workup

Procedures

  • Perform an oral biopsy.
    • The recently introduced, computer-assisted, oral brush biopsy is a detection tool providing evidence of cellular abnormalities in precancerous and cancerous lesions. With the aid of a highly specialized, neural, network-based, image-processing system specifically designed to detect oral epithelial precancerous and cancerous cells, the pathologist can detect as few as 1 or 2 abnormal individual cells in several hundred thousand cells.
    • The detection of 1 or 2 such abnormal cells is sufficient to warrant a histologic specimen obtained by scalpel biopsy.

Histologic Findings

The histopathologic features are highly variable, ranging from hyperkeratosis and hyperplasia to atrophy and severe dysplasia. The histologic assessment of oral epithelial dysplasia is notoriously unreliable. Many studies show interpathologist and intrapathologist variation in diagnosing dysplasia. Clearly, molecular studies are indicated to introduce more objectivity. Studies of p53 and other molecular markers, loss of heterozygosity, and DNA ploidy as molecular markers are currently underway.8

Besides the fact that the criteria for diagnosing dysplasia are ill defined, another serious problem exists. A tissue specimen from a biopsy may not be representative of the whole lesion.

More on Leukoplakia, Oral

Overview: Leukoplakia, Oral
Differential Diagnoses & Workup: Leukoplakia, Oral
Treatment & Medication: Leukoplakia, Oral
Follow-up: Leukoplakia, Oral
Multimedia: Leukoplakia, Oral
References
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References

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Further Reading

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Keywords

oral leukoplakia, leukoplakia, oral cancer, mouth cancer, smokeless tobacco, keratosis,

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Contributor Information and Disclosures

Author

Crispian Scully, MD, PhD, DSc, FRCPath, MRCS, CBE, MDS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FMedSci, FHEA, FUCL,DSc, DChD, DMed(HC), Dr hc., Professor, Director of Special Projects, Eastman Dental Institute for Oral Health Care Sciences; Professor, Special Needs Dentistry, University College; Professor, Oral Medicine, Pathology and Microbiology, University of London
Crispian Scully, MD, PhD, DSc, FRCPath, MRCS, CBE, MDS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FMedSci, FHEA, FUCL,DSc, DChD, DMed(HC), Dr hc. is a member of the following medical societies: Academy of Medical Science, British Society for Oral Medicine, International Association for Dental Research, and Royal Society of Medicine
Disclosure: Nothing to disclose.

Medical Editor

David P Fivenson, MD, Associate Director, St Joseph Mercy Hospital Dermatology Program, Ann Arbor, Michigan
David P Fivenson, MD is a member of the following medical societies: American Academy of Dermatology, Medical Dermatology Society, Michigan Dermatological Society, Michigan State Medical Society, Photomedicine Society, Society for Investigative Dermatology, and Wound Healing Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Warren R Heymann, MD, Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey
Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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