Leukoplakia

Definition:
A precancerous lesion that develops on the tongue or the inside of the cheek as a response to chronic irritation. Occasionally, leukoplakia patches develop on the female external genitalia.

Alternative Names:
Hairy leukoplakia; Smoker's keratosis

Causes, incidence, and risk factors:
Leukoplakia is primarily a disorder of the mucous membranes of the mouth, caused by irritation. Lesions usually develop on the tongue, but they may appear on the insides of the cheek.

Irritation may result from rough teeth or rough places on dentures, fillings, crown, and so on. It may also result from chronicsmoking or other tobacco use (smoker's keratosis). Pipe smoking involves a high risk for development of leukoplakia, as does holding chewing tobacco or snuff in the mouth for a prolonged period of time.

Occasionally, leukoplakia patches develop on the female external genital area, but the cause is unknown.

Like other mouth ulcers, leukoplakia may become a cancerous lesion.

The disorder is most common in the elderly.

"Hairy" leukoplakia of the mouth is an unusual form of leukoplakia that is seen only in AIDS, ARC and HIV positive individuals. It consists of fuzzy (hairy) white patches on the tongue and less frequently elsewhere in the mouth. It may resemble thrush, a Candida infection which, in adults, is also commonly associated with HIV and AIDS. Hairy leukoplakia may be one of the first signs of infection with the HIV virus.

Symptoms:
  • skin lesion/sore
    • usually on the tongue
    • possibly may be on the inside of the cheeks (occasionally on the genitals)
    • white or gray colored
    • thick, slightly raised
    • hardened surface


Signs and tests:
A white patch that has developed slowly over weeks to months. The lesion may eventually become rough textured and may become sensitive to touch, heat, spicy foods, or other irritation.

A biopsy of the lesion confirms the diagnosis and an examination of the biopsy specimen occasionally shows changes that indicate oral cancer.

Treatment:
The goal of treatment is to eliminate the lesion.

Removal of the source of irritation is the primary treatment for leukoplakia. Dental causes (rough teeth, irregular surface on dentures or filling, and so on) should be treated as soon as possible. Smoking or other tobacco use should be stopped.

Surgical removal of the lesion may be indicated if removal of the source of irritation is ineffective in reducing leukoplakia. The lesion is usually removed in your health care provider's office under local anesthesia.

Treatment of leukoplakia on the vulva is the same as treatment of oral lesions.

Expectations (prognosis):
Leukoplakia is usually harmless, and lesions usually clear in a few weeks or months after the source of irritation is removed. Approximately 3% of leukoplakia lesions develop cancerous changes.

Hairy leukoplakia is a harbinger of developing AIDS. Prognosis for AIDS remains poor although length and quality of life are improving.

Complications:


Calling your health care provider:
Call for an appointment with your health care provider if you have any lesions resembling leukoplakia or hairy leukoplakia.

Prevention:
Minimize or stop smoking or other tobacco use. Have rough teeth treated and dental appliances repaired promptly.

Safe sexual practices minimize the risk of contracting sexually transmitted diseases including AIDS.


Review Date: 8/14/2001
Reviewed By: Tracy S. d'Entremont, M.D., Division of Hematology-Oncology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network

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