Dental Problems

Premalignant Lesions -Leukoplakia

Leukoplakia is a type of premalignant lesions. It is precancerous condition which can be diagnosed at a early stage through routine oral examinations. In this article, there is a brief discussion on the premalignant lesions -leukoplakia -definitions, classifications and staging.

Definition:

  • Leukoplakia term originates from 2 Greek words -leuko meaning white and plakia meaning patch. Leukplakia is defined as a white patch on the mucosa that cannot be scraped off or rubbed and cannot be attributed to any of other diagnosable diseases.
  • Leukoplakia is also defined as the keratotic white lesion of the oral mucosa which cannot be characterized histopathologically or clinically as an entity of any other disease.
  • According to the WHO, leukoplakia is a whitish plaque or patch which cannot be characterized pathologically or clinically as any of the other diseases and which is neither associated with any other chemical or physical causative agent except for the tobacco use.

Classification:
There are various classification of leukoplakia which are discussed below:
According to the clinical description:
It is divided into homogenous and non homogenous:

  • Homogenous: This condition has white lesions completely. It is divided in to flat, wrinkled, corrugated and non homogenous.
    • Flat: This has smooth surface.
    • Wrinkled: It shows dry and cracked mud surface.
    • Corrugated: It is like a beach at the ebbing tide.
    • Pumice like: It has cristae with fine lines pattern.
  • Non homogenous: It is divided into speckled or nodular, verrucous, ulcerated and erythroleukoplakia
    • Speckled or nodular: It is characterized by white nodules or specks on the erythematous base.
    • Verrucous: It shows slow growing of papillary proliferations above the surface of the mucosa which might be heavily keratinized. Oral florid papillomatosis is one of this types which has extensive lesion.
    • Ulcerated: In this condition, the lesion exhibits redness at the periphery area of which white plaques or patches are present on the surface.
    • Erythroleukoplaka: In this, leukoplakia is in associated with the erythroplakia condition.

According to etiology: Leukoplakia is divided into two types:

  • Non tobacco induced and
  • Tobacco induced

According to histology: Leukoplakia is divided into two types:

  • Non dysplastic and
  • Dysplastic

According to the future oral cancer development risk:

Leukoplakia is divided into 3 types which include the following:

  • High risk sites:
    • Soft palate
    • Ventral or lateral surface of tongue
    • Floor of mouth
  • Lower risk sites:
    • Hard palate
    • Dorsum of tongue
  • Intermediate group:
    • Oral mucosa or all other sites

    According to extent: Leukoplakia is divided into two types:

    • Diffuse and
    • Localized

According to Banoczy:

  • Leukoplakia verrucosa: This condition is characterized by the verrucous proliferation, which is raised above the surface of the mucosa.
  • Leukoplakia erosive: In this condition, a lesion with rounded, slightly raised, whitish and/or red excrescence which may be described as nodules or granules.
  • Leukoplakia simplex: In this condition, there is a formation of a uniform raised plaque with regular edges, but varying in size. It corresponds its homogenous type.

Staging of leukoplakia:
Three parameters are usually used in this staging of leukoplakia which include size, clinical aspect and pathological features.

    • Size: Size is denoted by the letter ‘L’.
      • It is less than 2 cm.
      • It is between the range of 2 to 4 cm.
      • It is more than 4cm.
      • It is not specified.
    • Clinical aspect: This parameter is denoted by the letter ‘C’.
      • It is homogenous
      • It is non-homogenous
      • it is not specified
    • Pathological features: This parameter is denoted by the letter ‘P’.
      • It has not dysplasia
      • It has mild dysplasia
      • It has moderate dysplasia
      • It has severe dysplasia
      • It is not specified

The above article discusses about the definitions, classifications and staging of premalignant

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