43. PRENEOPLASTIC DISORDERS. LEUKOPLAKIA. ERYTHROPLAKIA

what are preneoplastic lesions?

morphologically altered tissue in which cancer is more likely to occur (Leukoplakia and erythroplakia)

what is a precancerous condition?

Generalised state associated with increased risk of cancer - E.g. lichen planus, aciNnic cheiliNs, discoid lupus erythematos

what is the etiology of precancerous lesions

factors such as

tobacco chewing/smoking

alcohol

what is leukoplakia?

a white plaque which cannot be scraped away, due to hyperkeratosis of the epithelium

what is the etiology of leukoplakia?

can occur at any age, more common >40

6x more likely to occur in smokers

What are the types of leukoplakia?

1. homogenous

2. non-homogenous

Describe homogenous leukoplakia

- uniform, flat, thin lesions

- uniform white colour

- shallow surface cracks

Describe non homogenous leukoplakia

-white and red lesions erythroleukoplakia

- irregular, speckled, nodular

when is the risk for malignancy of leukoplakia increased?

females

longer time without treatment

non-smokers

located on tongue and floor of mouth

non-homogenous type

epithelial dysplasia

size >200 mm2

how do we diagnose leukoplakia?

mucosal biopsy

what is the differential diagnoses for leukoplakia?

aspirin burn

chemical injury

oral pseudomembranous and hyper plastic candidiasis

friction lesions

linea alba

lichen planus

white sponge nevus

oral lichen planus

lichenoid reaction

how do we treat leukoplakia surgically ?

full removal of the lesion

- surgery or carbon dioxide laser

photodynamic therapy

cryotherapy

how do we treat leukoplakia non-surgically ?

- carotenoids

- vit A,C,E

what is erythroplakia?

a fiery red patch that cannot be categorised as any other lesion

who is most affected by erythroplakia?

mostly men

middle aged and elderly

malignancy rate of erythroplakia?

14-50%

what is the clinical appearance of erythroplakia?

flat depressed erythematous change od mucisa w/o patch lesion

solitary lesion mostly

<1.5mm diameter

predilection sites for erythoplakia are ?

soft palate

floor of the mouth

buccal mucosa

what is the malignant transformation risk?

very high

early identification and treatment is necessary

what is the treatment for erythroplakia?

surgical excision with cold knife or laser

erythroplakia diagnosis

clincal exam

biopsy

erythroplakia differntial diagnosis

oral candidiasis

oral histoplasmosis

tuberculosis

pemphigus

pemphigoid