eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery
Oral Leukoplakia, Idiopathic: Differential Diagnoses & Workup
Updated: Feb 7, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Leukoedema
Lichen planus
Chemical burn
Morsicatio buccarum (habitual cheek biting)
Candidosis
Psoriasis
Lupus erythematosus
White sponge nevus
Workup
Laboratory Studies
Idiopathic lesions and dysplastic lesions do not have any specific clinical appearance. Therefore, in any case, the clinical appearance is not a guide to the underlying microscopic characteristics. A definitive diagnosis of oral leukoplakia is made when any etiological cause other than tobacco/areca nut use has been excluded and histopathology has not confirmed any other specific disorder.1
Procedures
Biopsy obtainment, repeated as necessary, is essential.
Histologic Findings
The plaque may show hyperorthokeratosis or hyperparakeratosis. The granular layer is often thickened and extremely prominent in cases of hyperorthokeratosis, but it is seldom observed in even severe cases of hyperparakeratosis. Acanthosis, which refers to the abnormal thickening of the prickle cell layer, may also be observed. Epithelial changes suggestive of premalignancy include the following:
- Nuclear hyperchromatism
- Loss of polarity
- Increased number of mitotic figures
- Nuclear pleomorphism
- Altered nuclear-to-cytoplasmic ratio
- Deep cell keratinization
- Loss of differentiation
- Loss of intercellular adherence
Molecular markers that may indicate an increased likelihood of malignant transformation are (1) Mutations in the p53 gene, (2) Inappropriate expression of oncogenes (eg, cyclin D1), keratins, blood-group antigens and other cell-surface carbohydrates, and (3) DNA aneuploidy (when the amount of DNA is not an exact multiple of the diploid number). The latter emerges as one of the most promising prognostic indicators since oral cancer with poor survival consistently developed in human subjects with aneuploid dysplastic OL.2,3
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Differential Diagnoses & Workup: Oral Leukoplakia, Idiopathic |
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References
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Greenspan D, Jordan RC. The white lesion that kills--aneuploid dysplastic oral leukoplakia. N Engl J Med. Apr 1 2004;350(14):1382-4. [Medline].
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Laskaris G. Color Atlas of Oral Diseases in Children and Adolescents. New York, NY: Thieme Medical;2000.
Mincer HH, Coleman SA, Hopkins KP. Observations on the clinical characteristics of oral lesions showing histologic epithelial dysplasia. Oral Surg Oral Med Oral Pathol. Mar 1972;33(3):389-99. [Medline].
Pindborg JJ, Roed-Peterson B, Renstrup G. Role of smoking in floor of the mouth leukoplakias. J Oral Pathol. 1972;1(1):22-9. [Medline].
Shafer WG, Hine MK, Levy BM, eds. A Textbook of Oral Pathology. 4th ed. Philadelphia, Pa: WB Saunders;1983.
Silverman S Jr, Gorsky M, Lozada F. Oral leukoplakia and malignant transformation. A follow-up study of 257 patients. Cancer. Feb 1 1984;53(3):563-8. [Medline].
Silverman S, Bhargava K, Smith LW, Malaowalla AM. Malignant transformation and natural history of oral leukoplakia in 57,518 industrial workers of Gujarat, India. Cancer. Oct 1976;38(4):1790-5. [Medline].
Warnakulasuriya S, Johnson NW, van der Waal I. Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med. 2007;36:575-580.
Further Reading
Keywords
oral leukoplakia, OL, focal keratosis, hyperkeratosis, mouth cancer, leukoplakia, oral plaque, mouth plaque, idiopathic leukoplakia, idiopathic oral leukoplakia, premalignant oral lesion, premalignant mouth lesion, precancerous lesion, speckled leukoplakia, verrucous leukoplakia, homogenous leukoplakia, speckled OL, verrucous OL, homogenous OL
Differential Diagnoses & Workup: Oral Leukoplakia, Idiopathic