✅ Summary
Leukoplakia, erythroplakia, and oral lichen planus (OLP) are among the most recognized oral potentially malignant disorders (OPMDs) described by the World Health Organization (WHO, 2022).
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✅ Introduction
Oral potentially malignant disorders (OPMDs) are lesions or conditions associated with an increased risk of cancer development in the oral cavity. The three most clinically significant OPMDs are leukoplakia, erythroplakia, and oral lichen planus. These conditions differ in appearance, etiology, and histopathology but share overlapping pathways of chronic inflammation, oxidative stress, and genetic mutation that predispose to carcinogenesis.
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1. Leukoplakia
Leukoplakia is defined as a white patch or plaque of the oral mucosa that cannot be rubbed off and cannot be characterized clinically or histopathologically as any other condition.
➤ Clinical features: Homogeneous (flat, thin white areas) or non-homogeneous (nodular, verrucous, or speckled).
➤ Histopathology: Ranges from hyperkeratosis without dysplasia to varying degrees of epithelial dysplasia.
➤ Malignant transformation risk: Between 1–20%, depending on the presence of dysplasia, tobacco use, and lesion type (higher in non-homogeneous types).
2. Erythroplakia
Erythroplakia presents as a velvety, red, well-demarcated lesion that cannot be attributed to any other condition.
➤ Clinical features: Soft texture, easily bleeding surface, usually asymptomatic but occasionally tender.
➤ Histopathology: Frequently exhibits severe epithelial dysplasia, carcinoma in situ, or invasive carcinoma at diagnosis.
➤ Malignant transformation risk: Highest among OPMDs — more than 50% of cases show high-grade dysplasia or carcinoma.
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OLP is a chronic inflammatory disease mediated by T-cell immune responses against basal keratinocytes.
➤ Clinical features: Bilateral white striae (Wickham’s striae), erosive, or atrophic forms affecting buccal mucosa, tongue, and gingiva.
➤ Histopathology: Band-like lymphocytic infiltrate at the epithelial-connective junction, basal cell degeneration, and “saw-tooth” rete ridges.
➤ Malignant transformation risk: Low (about 1–2%), higher in erosive and atrophic variants.
馃搳 Comparative Table: Leukoplakia, Erythroplakia, and Oral Lichen Planus
| Feature | Leukoplakia | Erythroplakia | Oral Lichen Planus |
|---|---|---|---|
| Clinical Appearance | White plaque or patch, non-scrapable | Red, velvety lesion, sharply demarcated | White striae or erosive lesions, often bilateral |
| Etiology | Tobacco, alcohol, chronic irritation | Tobacco, alcohol, HPV, chronic trauma | Autoimmune-mediated T-cell response |
| Histopathology | Hyperkeratosis, epithelial dysplasia | Severe dysplasia or carcinoma in situ | Basal cell degeneration, lymphocytic infiltrate |
| Malignant Potential | Low to moderate (1–20%) | High (>50%) | Low (1–2%), especially erosive forms |
| Common Sites | Buccal mucosa, tongue, floor of mouth | Floor of mouth, soft palate, ventral tongue | Buccal mucosa, gingiva, tongue |
| Relationship | May progress to erythroplakia if dysplasia worsens | Represents advanced dysplastic stage of leukoplakia | May coexist with leukoplakia due to chronic irritation |
馃挰 Discussion
Leukoplakia, erythroplakia, and OLP represent different manifestations within the spectrum of OPMDs. Despite their diverse origins—reactive, idiopathic, or autoimmune—they share common molecular alterations such as p53 mutation, increased Ki-67 expression, and loss of epithelial cohesion (E-cadherin dysfunction). Erythroplakia is considered the most dangerous lesion, often diagnosed at a later stage when dysplasia is severe or carcinoma has already developed. Leukoplakia, on the other hand, offers a window of opportunity for early intervention. Oral lichen planus is generally benign, yet chronic inflammation and oxidative stress can trigger dysplastic transformation in long-standing erosive forms.
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Although leukoplakia, erythroplakia, and oral lichen planus differ in etiology and appearance, all are linked by their potential for malignant transformation. Recognizing their distinct and overlapping features allows clinicians to establish accurate diagnoses, initiate early treatment, and reduce cancer risk through continuous monitoring and patient education.
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1. Biopsy all persistent red, white, or mixed oral lesions to assess dysplasia.
2. Eliminate risk factors such as tobacco and alcohol use.
3. Monitor patients with OLP, especially erosive types, every 3–6 months.
4. Use photographic records for lesion evolution tracking.
5. Educate patients about the signs of malignant transformation: non-healing ulcers, induration, or bleeding areas.
馃摎 References
✔ Warnakulasuriya, S., Kujan, O., Aguirre-Urizar, J. M., Bagan, J. V., Gonz谩lez-Moles, M., Kerr, A. R., ... & Ogden, G. R. (2021). Oral potentially malignant disorders: A consensus report from an international seminar on nomenclature and classification. Oral Diseases, 27(8), 1862–1880. https://doi.org/10.1111/odi.13704
✔ Brouns, E. R., Baart, J. A., Bloemena, E., & Karagozoglu, K. H. (2019). Erythroplakia: An update on clinical, histopathologic, and molecular features. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 128(5), 517–526. https://doi.org/10.1016/j.oooo.2019.07.007
✔ Villa, A., & Woo, S. B. (2017). Leukoplakia—A diagnostic and management algorithm. Journal of Oral and Maxillofacial Surgery, 75(4), 723–734. https://doi.org/10.1016/j.joms.2016.10.012
✔ Gonz谩lez-Moles, M. A., Warnakulasuriya, S., & Ramos-Garc铆a, P. (2021). Oral lichen planus: New evidence about the potential malignant transformation of this chronic disease. Journal of Oral Pathology & Medicine, 50(6), 509–520. https://doi.org/10.1111/jop.13196
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