Morphologically altered tissue in which cancer is more likely to occur than its apparently normal counter part.
Leukoplakia is defined as ‘white patch’ or ‘plaque’ in the oral cavity, which cannot be scraped off or stripped off easily and more over which cannot be charectarized clinically or pathologically as any other disease. –WHO
Redefined as a “ predominantly white lesion of oral mucosa that cannot be characterized as any other definable lesion; some oral leukoplakia will transform into cancer” (Axell T, 1996)
Granular or Nodular Leukoplakia
Speckled or Erythroleukoplakia
Proliferative Verrucous Leukoplakia
Lesions of the oral mucosa, which are white, results from
Thickened layer of keratin
Intercellular epithelial edema
Reduced vacularity of subjacent connective tissue.
White or yellow lesion may also be due to
Fibrin exudate covering an ulcer
Submucosal deposit or fungal colonies.
1. Actinic chellitis
2. Idiopathic leukoplakia
2. Mucosal burns
3. Fordyce's granules
Regezi 5th edition
2. Lichen planus
3. Lupus erythematosus
Pre neoplastic and
Other white lesion:
Non epithelial white
White lesion classification :
Scrapable white lesion :
• Pseudo membraneus candidiasis
• Thermal burn
• Sloughing traumatic burn
• Tooth paste or mouth wash
• Chemical burn
• Secondary syphilis
Nonscrapable white lesion:
• Linea alba
• Tobacco pouch keratosis
• Lichen planus
• Nicotine stomatitis
• Hairy leukoplakia
• White sponge nevus
• Hereditary benign intraepithelial
• Tertiary syphilis
Morphologically altered tissue in which cancer is more likely to
occur than its apparently normal counter part.
Palatal changes associated with reverse smoking
Generalized state or condition associated with significantly increased Risk for
Oral Sub Mucous Fibrosis
Oral Lichen Planus
Also known as Leukokeratosis;
Plakia = patch
Leukoplakia is defined as ‘white patch’ or ‘plaque’ in the
oral cavity, which cannot be scraped off or stripped off
easily and more over which cannot be charectarized
clinically or pathologically as any other disease. –WHO
Redefined as a “ predominantly white lesion of oral
mucosa that cannot be characterized as any other
definable lesion; some oral leukoplakia will transform
into cancer” (Axell T, 1996)
Leukoplakia should be used to recognize white plaques of questionable risk
having excluded(other) known disease or disorder that carry no increased risk
- Warnakulasuriya (2007)
widely used in two forms;
Smoking tobacco (cigarette,bidi)
Has a strong synergistic effect
with tobacco relative to oral
Causative factor for leukoplakia of the lower lip vermilion
Usually associated with actinic cheilosis
Candida albicans-candidal leukoplakia
Human papilloma virus- subtypes 16 and 18
Several keratotic lesions had been viewed as variants of
leukoplakia, but now are considered not to be a precancers
Site of Occurence
Lateral aspect of the tongue was most common lesion site(25.9% of patients)
Buccal mucosa (16.7%)
Floor of the mouth (9.3%)
Palate, lip, and ventral surface of the tongue (each 7.4%)
Dorsal surface of the tongue and commissures (each, 3.7%).
Age : Occurs more commonly in older age group (>50 yrs).
Prevalence increases with age.
Gender : Males > Females.
Extent- May vary from small, localized, irregular patches to diffuse lesions.
Color- May be white/ yellowish in color.
Surface- The surface of the lesion is finely wrinkled in appearance,
may feel rough on palpation.
Symptoms- The patients may complain of increase thickness of mucosa.
may be totally asymptomatic to burning sensation with ulcerated or nodular type.
Homogenous white patch/ plaque
No red component
Fine, white, grainy texture.
Low risk malignant transformation rate
Localized or extensive
“cracked mud appearance”
Non Homogenous/ Heterogenous Leukoplakia/
Red and white mixed lesion
White lesions interspersed with red or atrophic areas
Higher risk of malignant transformation
Bulbous and crowded rete pegs
Non homogenous/ Nodular Leukoplakia
White lesion with raised, pebbly surface with
polypoid outgrowths (nodules) on an erythematous
Very fine, pin head sized or larger, rounded, red or
Associated with high malignant transformation rate
Appearance often similar to Candidiasis
Mild complaints of localized pain/ discomfort
Bulbous rete pegs
White lesion with raised corrugated surface
White component is thicker than red & protrudes
over surface mucosa
The surface exhibits multiple papillary projections
which are heavily keratinized
60 – 80 years
Bulbous rete pegs
Proliferative Verrucous Leukoplakia
Persistent , extensive verrucoid/ wart like appearance
Begins as simple hyperkeratosis, slow-growing, persistent & irreversible,
but tends to spread, becomes multifocal with an exophytic surface.
Most commonly resistant to all forms of therapy as recurrence is common.
Strong female predilection
> 60 years
Highest risk of malignant transformation.
Site- often bilateral & affects mandibular alveolar &buccal mucosa
Lesion: Firm, white leathery plaques
Site: Cheeks, lips, palate, tongue
Diagnosis: PAS (Periodic Acid Schiff) +.
Epithelial proliferation (inflammatory/ reactive changes in epithelium)
Hyphae in leukoplakic lesions
• Blood investigation
• Tolidine blue staining or lugol’s iodine
• Exfoliative cytology
Hallmarks of histological aspects of leukoplakia is-
epithelial hyperplasia and surface hyperkeratosis.
The keratin layer may consist of :
with no granular cell layer and
epithelial nuclei are retained in
Orthokeratin ( hyperorthokeratosis)
with granular cell layer and the
nuclei are lost in the keratin layer.
Combination of both
Evidence of epithelial dysplasia is found in only 5% to 25% of the
Leuokoplakia diagnosed as moderate
Leukoplakia diagnosed as severe
• Elimination of etiological factors
• Surgical management
• Cyrosurgery : Use of extreme cold to destroy the abnormal
or diseased tissue. Eg: liquid nitrogen, argon
• CO2- laser surgery
• Photodynamic therapy : It’s a treatment that uses drug,
called photosensitizing agent and particular type of light.
when photosensitizer are exposed to certain wavelength of
light, they produce a form of oxygen that kills nearby cells
It comprises a loss in the uniformity of the individual cells as well as loss in
their architectural orientation.
1.Increased mitotic activity
2.Abnormal mitotic figures
3.Increased nuclear-cytoplasmic ratio
4.Enlarged nuclei and cells
6.Pleomorphic nuclei and cells
7.Large and prominent nucleoli
9.Bulbous or teardrop shaped rete rigdes.
10.Loss of polarity
11.Keratin or epithelial pearls
12.Loss of typical epithelial cell cohesiveness.
Histopathological features of epithelial dysplasia :
Loss of polarity Reduction in cellular
Increased mitotic figures