Hairy Leukoplakia Workup

  • Author: Denis P Lynch, DDS, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 13, 2012
 

Laboratory Studies

  • In most cases, the diagnosis is established on clinical basis, while a definitive diagnosis requires both an appropriate histopathological appearance and the demonstration of EBV DNA, RNA, or protein within the epithelial cells of the lesion.
  • Several immunohistochemical and in situ hybridization kits are commercially available for this purpose,[11] whilst tissue biopsy is indicated only if the lesions are unusual in appearance or ulcerated and suggest cancer.
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Procedures

It is important to differentiate hairy leukoplakia from other, more serious, oral lesions that may have a similar clinical appearance. In some cases, biopsy and histologic examination are required to exclude cancer.

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Histologic Findings

The histopathology of hairy leukoplakia is characterized by 5 major features.

  • Hyperkeratosis of the upper epithelial layer that represents an altered pattern of keratin expression in the squamous epithelial cells: This hyperkeratosis is largely responsible for the characteristic shaggy or "hairy" gross appearance of the lesion. Superficial infections of the hyperkeratinized epithelium with bacteria or Candida may also be seen.
  • Parakeratosis of the superficial epithelial layer: This abnormal persistence of cell nuclei in the superficial epithelial layers may represent incomplete squamous differentiation.
  • Acanthosis of the stratum spinosum in the epithelial mid layer: This abnormal expansion of cells occurs with foci or layers of ballooning koilocyte-like cells. The nuclei have a homogenous ground-glass appearance and may contain Cowdry type A intranuclear inclusions.
  • Minimal or no inflammation in the epithelial and subepithelial tissues
  • Histologically normal basal epithelial layer

Although these characteristic histologic features of hairy leukoplakia are highly suggestive of the diagnosis, none is unique to the lesion. Thus, a definitive diagnosis of hairy leukoplakia requires both an appropriate histologic/cytologic appearance and demonstration of EBV DNA, RNA, or protein within the epithelial cells of the lesion.

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Contributor Information and Disclosures
Author

Denis P Lynch, DDS, PhD  Professor of Oral and Maxillofacial Pathology, Associate Dean for Academic Affairs, Office of the Dean, Marquette University School of Dentistry

Denis P Lynch, DDS, PhD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Dental Association, International Association for Dental Research, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Sanjiv S Agarwala, MD  Chief of Oncology and Hematology, St Luke's Cancer Center, St Luke's Hospital and Health Network; Professor, Temple University Shool of Medicine

Sanjiv S Agarwala, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Head and Neck Surgery, American Society of Clinical Oncology, Eastern Cooperative Oncology Group, and European Society for Medical Oncology

Disclosure: BMS Honoraria Speaking and teaching; Novartis Consulting fee Consulting; Merck Consulting fee Consulting

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Samer Bleibel, MD, Hunter Sams, MD, Alan Boyd, MD, Olga Kozyreva, MD, and Sarah K. May, MD, to the development and writing of this article.

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