Dental Problems

Oral Precancer Erythroplakia -Overview

ErythroplakiaErythroplakia is one of the precancerous conditions. ERythroplakia must also be diagnosed and treated at early stage. This can be done through routine oral check ups. In this article, there is a brief discussion on the oral precancer erythroplakia -overview. Read on to know more.

Erythroplakia:

Erythroplakia is also known as erythroplasia of Queyrat. It is a persistent velvety red color patch. Reddish color results due to the absence of keratin surface layer and due to the presence of papillae connective tissue containing enlarged capillaries that are projected closer to the surface.

Evolution:

  • A nonhemorrhagic red color patch of upper aero-digestive tract area was seen in the vocal cord lesion which was first mentioned and was reported in the year 1852.
  • However, the first description of erythroplakia in a paper was reported by Queyrat in 1911. It reported a red macule over the glans penis of the syphilitic patient. Queyrat coined this term erythroplakia.
  • During the same time period, Rubin termed incipient carcinoma in order to describe the erythroplakia microscopic features. This is the most common histopathologic diagnosis based on his experience on the uterine cervix lesions as carcinoma in situ.

Definition:

  • Erythroplakia is defined as any area or site of reddened and velvety textured mucosa which cannot be identified either on the basis of hispathologic examination or clinical examination as being caused by any other disease process or inflammation.
  • Erythroplakia can also be defined as red and chronic mucosal macule that cannot be attributed to inflammatory, vascular or traumatic causes and cannot be given any specific diagnostic name.

Classification:

Erythroplakia can be classified into the following types:

  • Homogenous
  • Erythroplakia interspersed with the leukoplakia patches
  • Granular or speckled

Etiology:

The etiology of erythroplakia includes the following:

  • Idiopathic
  • Smoking
  • Alcohol
  • A secondary infection or the super infection with candidiasis which might be associated with the dysplastic oral mucosal cells. Often candida albicans has been demonstrated in the erythroleukoplakia lesions and white component and/or the red component of these lesions disappears and diminishes after antifungal therapy, at least in some cases.

Clinical Features:

  • Age and sex:

    Male predilection and the most common in the 6th decade and the 7th decade of life.

  • Sites:

    • Erythroplakia generally occurs on all the mucosal surfaces of the neck and head area.
    • However, half of all cases are found on the intraoral and vermilion surfaces, , with the rest of them being divided evenly between the pharynx and larynx.
    • Vermillion lesions are most often seen on lower lip and are relatively common.
    • Intraorally, the ventral and lateral tongue, soft palate and oral floor are involved most frequently.
  • Symptoms of erythroplakia:

    As the name implies, it is asymptomatic.

  • Signs:

    • It shows red patch or macule and is nonelevated on the epithelial surface.
    • The cause of red appearance is not known, but it may be related to a hike in the underlying blood vessels number through which the flow of blood occurs, which in turn might be secondary to the immunological response or localized inflammatory caused by dysplastic, I.e. foreign, eothelial cells.
    • The color might result from a lack of extreme thinness of epithelium or surface keratin in some cases.
  • Homogenous form:

    • It is commonly found on the soft palate and buccal mucosa and rarely on the floor of mouth and tongue.
    • Homogenous form appears as a soft, bright red, velvety lesion with scalloped or straight, well-demarcated margins.
    • It is quite extensive in its size.
  • Size:

    Typically, the lesion is less than 1.5cm in greatest diameter and the half size of this size lesions are less than 1.0 cm, but there are lesion which are larger than 4cm.

  • Margins:

    Usually, it is quite sharply demarcated from the pink mucosa surrounding and it surface is smooth and shows regular in coloration.

  • Speckled or granular form:

    These are red, soft lesions which are elevated slightly with regular outlines and finely nodular and granular surface speckled with white color tiny plaques.

  • Smooth erythroplakia:

    It is soft to palpitation and often has been described as having velvety feel. Though, the pebbled lesions tend to be firm somewhat, but erythroplakia actually never becomes indurated or hard, until there is a development of invasive carcinoma from within.

  • Erythroleukoplaka:

    • It is common to see this condition, where erythroplakia is adjacent or admixed to leukoplakia in mouth.
    • In these kind of lesions, the red sites are the areas which are most likely to develop or contain dysplastic cells and therefore these areas must be biopsied most readily and carefully clinically examined.
    • Erythroplakia interspersed with leukoplakia patches in which erythematous sites are irregular and are often not bright as homogenous kind,. These are seen on the floor of mouth and on tongue most frequently.
    • The borders might be blend impercibly or well circumscribed with the oral mucosa surrounding.
  • Unlike leukoplakia, erythroplakia is the seldom multiple and it covers extensive areas in the mouth. Also, it seems seldom to laterally expand after initial diagnosis of the condition, although this might be an artifactual feature. This is because of the reason that most lesions are destroyed immediately or removed completely after formal diagnosis.

Histopathological features:

  • Erythroplakia exhibits epithelial changes which range from mild dysplasis to carcinoma in situ and even invasive carcinoma.
  • Epidermoid carcinoma might show any degree of differentiation from poorly differentiated to well differentiated. It also appears in multi-centric origin.
  • The carcinoma in situ usually shows epithelial dysplasia all throughout the epitheliu, without any invasion in the underlying connective tissue.
  • The rete pegs connective tissue may extend very high in the epithelium and the tips of these rete pegs are often very thin. Capillaries in the superficial pegs are dilated frequently and the absence of a significant amount of surface parakeratin or orthokeratin or at at the most only thin layer contributes to red color lesion.
  • The spinous layer consists of cells displayingpleomorphism, hyperchromatis, atypia and increase in the number of mitotic figures.

The above article discusses about the over view of oral precancer erythroplakia condition.

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