Oral Leukoplakia Workup

  • Author: Christopher M Harris, MD, DMD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Nov 17, 2011
 

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]

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Procedures

Biopsy obtainment, repeated as necessary, is essential.

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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

Yang et al analyzed the relationship between clinical features of OL using endoscopy with narrow-band imaging histopathology. They concluded that flexible endoscopy can be a successful tool for examining OL.[2]

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.[3, 4]

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Contributor Information and Disclosures
Author

Christopher M Harris, MD, DMD  Residency Program Director, Department of Oral and Maxillofacial Surgery, Maxillofacial Tumor and Reconstruction, Naval Medical Center Portsmouth

Christopher M Harris, MD, DMD is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons and American Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David J Terris, MD, FACS  Porubsky Professor and Chairman, Department of Otolaryngology, Medical College of Georgia

David J Terris, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Association for the Advancement of Science, American Bronchoesophagological Association, American College of Surgeons, American Head and Neck Society, Federation of American Societies for Experimental Biology, International Association of Endocrine Surgeons, Phi Beta Kappa, Radiation Research Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Nader Sadeghi, MD, FRCSC  Professor, Otolaryngology-Head and Neck Surgery, Director of Head and Neck Surgery, George Washington University School of Medicine and Health Sciences

Nader Sadeghi, MD, FRCSC is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, American Thyroid Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

  1. Pathology & Genetics. Head and Neck Tumours. In: World Health Organization. World Health Organization of Tumours. In: Barnes L, Eveson JW, Reichart P, Sidransky D, eds. Lyon: International Agency for Research of Cancer (IARC) IARC Press; 2005:177-179.

  2. Yang SW, Lee YS, Chang LC, Hwang CC, Luo CM, Chen TA. Use of endoscopy with narrow-band imaging system in evaluating oral leukoplakia. Head Neck. Nov 3 2011;[Medline].

  3. 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].

  4. Sudbø J, Lippman SM, Lee JJ, Mao L, Kildal W, Sudbø A. The influence of resection and aneuploidy on mortality in oral leukoplakia. N Engl J Med. Apr 1 2004;350(14):1405-13. [Medline].

  5. Jeong WJ, Paik JH, Cho SW, Sung MW, Kim KH, Ahn SH. Excisional biopsy for management of lateral tongue leukoplakia. J Oral Pathol Med. Nov 12 2011;[Medline].

  6. Lin HP, Chen HM, Cheng SJ, Yu CH, Chiang CP. Cryogun cryotherapy for oral leukoplakia. Head Neck. Nov 15 2011;[Medline].

  7. Lippman SM, Batsakis JG, Toth BB, Weber RS, Lee JJ, Martin JW. Comparison of low-dose isotretinoin with beta carotene to prevent oral carcinogenesis. N Engl J Med. Jan 7 1993;328(1):15-20. [Medline].

  8. Garewal HS, Katz RV, Meyskens F, Pitcock J, Morse D, Friedman S. Beta-carotene produces sustained remissions in patients with oral leukoplakia: results of a multicenter prospective trial. Arch Otolaryngol Head Neck Surg. Dec 1999;125(12):1305-10. [Medline].

  9. Einhorn J, Wersall J. Incidence of oral carcinoma in patients with leukoplakia of the oral mucosa. Cancer. Dec 1967;20(12):2189-93. [Medline].

  10. Cawson RA, Odell EW. Essentials of Oral Pathology and Oral Medicine. 6th ed. New York, NY: Churchill Livingstone;1998.

  11. Cawson RA, Speight P, Binnie WH, Wright J, eds. Luca's Pathology of Tumors of the Oral Tissues. 5th ed. New York, NY: Churchill Livingstone;1998.

  12. Eveson JW. Oral premalignancy. Cancer Surv. 1983;2:403-424.

  13. Haya-Fernández MC, Bagán JV, Murillo-Cortés J, Poveda-Roda R, Calabuig C. The prevalence of oral leukoplakia in 138 patients with oral squamous cell carcinoma. Oral Dis. Nov 2004;10(6):346-8. [Medline].

  14. Kramer IR, El-Labban N, Lee KW. The clinical features and risk of malignant transformation in sublingual keratosis. Br Dent J. Mar 21 1978;144(6):171-80. [Medline].

  15. Laskaris G. Color Atlas of Oral Diseases in Children and Adolescents. New York, NY: Thieme Medical;2000.

  16. 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].

  17. 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].

  18. Shafer WG, Hine MK, Levy BM, eds. A Textbook of Oral Pathology. 4th ed. Philadelphia, Pa: WB Saunders;1983.

  19. 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].

  20. 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].

  21. 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.

 
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