Randy Jacobs, M.D. Patient Education

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Leukoplakia may be defined as an abnormal hyperplastic (increase in the number of normal cells) response of mucous membranes with excessive keratinization.  Simply speaking, it is a whitish thickening of the tissues that line such areas as the mouth, anus, or vagina.  Leukoplakia occurs as superficial patches of various shapes and sizes that come together to form diffuse sheets.  The lips, gums, cheeks, and the back of the tongue are the most common sites, but the lesion may arise on the anus or genitalia as well.

Early on, the lesions may not be symptomatic, but  may later become exquisitely sensitive to the ingestion of hot  or spicy  foods.  In time, these thickened areas of tissue may also form ulcers or  fissures.


External irritants play a significant role in the development of leukoplakia, and the type of irritant will influence the location of the lesion.  Friction from poorly fitting dentures, misaligned teeth, or cheek-biting are common factors.  Pipe smokers are also more susceptible for leukoplakia of the palate or tongue.  Cigarette smoking also tends to cause leukoplakic esions of the mouth.


Leukoplakia is a changing process and may eventually develop into in situ or invasive squamous cell carcinoma, even though leukoplakia may exist for years without indication of carcinoma.  Typically, carcinoma associated with leuloplakia usually begins as localized induration, often around a fissure or small ulcer.  On the other hand, small inflamed patches may be the site of a rapidly growing tumor, which although having insignificant appearing local inflammation, may grow to involve the cervical lymphatics of the neck, and therefore, the spread of cancer.



In dealing with leukoplakia, it must be remembered that cancer  can be so frequently encountered that vigorous treatment should be considered in each case.  The use of tobacco should be stopped, and proper dental care obtained.  Small, non-infiltrated lesions may be observed without treatment, while irritatnt factors are removed.  Larger or thicker lesions should be biopsied through the most hyperplastic or atypical area.  Lesions which don't improve may be surgically excised or may be adequately destroyed with electrodessication or cautery if one is certain of the benign diagnosis.


In summary, leukoplakia can be considered a premalignant condition more commonly, seen in men, older individuals, and those having external irritants previously described above.  Leukoplakia is a treatable condition, that if looked after properly, can prevent the spread of malignant squamous cell carcinoma.