eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Leukoplakia, Oral: Follow-up

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

Follow-up

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.

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.
  • Advise patients to eat a diet high in fresh fruits and vegetables.

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.13
    • 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

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.

Patient Education

  • Patients should avoid alcohol, tobacco, and betel.
  • 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.

Miscellaneous

Medicolegal Pitfalls

  • Misdiagnosis is possible if adequate biopsy specimens are not taken.
  • Early treatment is indicated, and complicating factors should be excluded.
 


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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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