Leukoplakia and erythroplakia

When it comes to oral health, doctors and dentists keep an eye out for two conditions called leukoplakia and erythroplakia. These are two types of lesions, or tissue changes, that may occur within the mouth and/or throat—and may potentially be precancerous (though not always).

Leukoplakia is a gray or white area in the mouth or throat that doesn’t come off when scraped. Erythroplakia is a red area that is either flat or raised. If it’s scraped, erythroplakia tends to bleed easily.

Sometimes, patients have a mix of both types of tissue changes, known as erythroleukoplakia. In this case, the patch within the mouth or throat has red and white sections.

These oral conditions may be discovered by a dentist during a routine cleaning or by the patient during regular toothbrushing. Patients whose mouth or throat looks or feels different than normal are urged to consult a doctor or dentist.

Risk factors

There are several risk factors for leukoplakia and erythroplakia that increase the risk of developing either or both conditions. They include:

• Tobacco use
• Excessive alcohol consumption
• Poorly fitting dentures that rub the inside of the mouth

However, sometimes leukoplakia and erythroplakia occur without a clear cause.

How are leukoplakia and erythroplakia linked to cancer?

Both leukoplakia and erythroplakia are possible precancerous conditions of the mouth, for both oral cancer and oropharyngeal cancer, which is a type of cancer that begins in the middle part of the throat.

It’s important to remember that not all patches in the mouth are cancerous or even precancerous. Precancerous lesions are known as dysplasia, and may be categorized as mild, moderate or severe. Severe dysplasia is more likely to become cancerous.

How are leukoplakia and erythroplakia diagnosed?

Doctors may perform a biopsy, as this is the only way to find precancerous or cancerous cells in a lesion. During a biopsy, the doctor removes tissue cells from the lesion and a pathologist examines them, checking to see whether abnormal cells are present.

In the case of oral cavity lesions like leukoplakia and erythroplakia, doctors may perform a brush biopsy, a technique that uses a brush to remove cells from all of the layers of a lesion.

Other diagnostic tools that doctors may use include:

• Fluorescence staining: A patient uses a special mouth rinse, and the doctor then examines the mouth using a special fluorescent light. Abnormal tissue look different, making it easier to see abnormal areas.
• Toluidine blue stain: A blue dye is used to coat lesions in the mouth, with areas that turn darker indicating an increased likelihood of precancerous or cancerous cells.
• Exfoliative cytology: This is a method of collecting cells from the mouth and throat using a brush, wooden stick or piece of cotton to gently scrape cells from the oral cavity. The cell samples are then examined under a microscope.
• Scalpel biopsy: This is the gold standard for a definitive diagnosis.

Treatment

Patients diagnosed with leukoplakia and/or erythroplakia due to tobacco or alcohol use may be asked to stop smoking or drinking to see whether the lesions resolve on their own.

Should a lesion not go away on its own, the doctor may surgically remove it using a laser or scalpel. However, new treatments are under development, with research studies demonstrating that retinoids and beta carotene may be used in the future.

When doctors discover cancer cells in a lesion, they typically give the patient recommended treatment options for oral cavity and oropharyngeal cancers. There are a number of evidence-informed treatment options, including surgery, radiation, chemotherapy and immunotherapy.

Patients should rely on their care team as a good source of information about oral health, as they’re able to provide additional resources, answer questions and help facilitate the recovery process after treatment.