Dermatologic Manifestations of Oral Leukoplakia Follow-up

  • Author: Crispian Scully, MD, PhD, MDS, CBE, MDS, MRCS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, DSc, DChD, DMed(HC), Dr(HC) ; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 29, 2010
 

Further Outpatient Care

Examine patients with leukoplakias regularly at 3- to 6-month intervals. Detection of clinical changes, such as erosions or nodule formation, warrants a biopsy. An oral brush biopsy may be helpful in detecting dysplasia.

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Deterrence/Prevention

Counsel patients against tobacco use. The percentage of nonsmokers who develop malignancy in a leukoplakia is greater than the percentage of smokers who develop a malignancy in a leukoplakia; however, the condition is more common in smokers such that the overall number of malignancies that arise in leukoplakias is greater in smokers.

Advise patients to avoid alcohol use. Additionally, advise patients to eat a diet high in fresh fruits and vegetables.

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Complications

Some leukoplakias are potentially malignant. Dysplasia currently appears to be the best predictor of malignant potential. As many as 25% of leukoplakias are dysplastic at the first visit. DNA ploidy studies may help predict outcomes.[17] Malignant change appears to be more frequent among nonsmokers than among smokers.

A poorer prognosis is noted in the following:

  • Nonsmokers
  • Females
  • Moderate or severe epithelial dysplasia
  • Lesions in high-risk sites, such as the floor of the mouth
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Prognosis

Estimates of malignant transformation vary from 3-33% over a 10-year period. However, many innocuous leukoplakias are not always followed up in some centers, and the studies are often small. As many as 30% of leukoplakias can regress if habits are stopped.

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Patient Education

Patients should avoid alcohol, tobacco, and betel. Additionally, patients should consume a diet rich in fruits and vegetables.

For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. Also, see eMedicine's patient education article Cancer of the Mouth and Throat.

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Contributor Information and Disclosures
Author

Crispian Scully, MD, PhD, MDS, CBE, MDS, MRCS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, DSc, DChD, DMed(HC), Dr(HC)  Professor of Oral Medicine, Bristol University; Emeritus Professor of Oral Medicine and Special Care Dentistry, University College London; Professor, Oral Medicine, Pathology, and Microbiology, University of London; Visiting Professor at Universities of Athens, Bristol, Edinburgh, Granada, and Helsinki

Crispian Scully, MD, PhD, MDS, CBE, MDS, MRCS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, 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, European Association for Oral Medicine, International Academy of Oral Oncology, International Association for Dental Research, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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.

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.

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 Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

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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Homogeneous leukoplakia.
Erythroleukoplakia.
Verrucous or nodular leukoplakia.
Carcinoma referred to as a leukoplakia.
 
 
 
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