Leukoplakia, oral II

Leukoplakia, oral II

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS:

• White oral lesions that can be wiped away:
• Candida
• Aspirin burn
• White oral lesions that cannot be rubbed off:
• Traumatic or frictional keratosis (e.g., linea alba)
• Leukoedema
• Galvanic keratosis
• Lichen planus
• Verrucous carcinoma
• Lupus
• Squamous cell carcinoma
• Oral hairy leukoplakia, commonly on the lateral border of the tongue with a bilateral distribution
• Leukokeratosis nicotina palati

LABORATORY:

N/A

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS:

• Biopsy specimens range from hyperkeratosis to invasive carcinoma
• 6% at initial biopsy are invasive carcinoma
• 4% subsequently undergo malignant transformation
• Location is important: 60% on floor of mouth are cancerous; rarely so on buccal mucosa

SPECIAL TESTS:

N/A

IMAGING:

N/A

DIAGNOSTIC PROCEDURES:

Biopsy necessary to rule out carcinoma

TREATMENT

APPROPRIATE HEALTH CARE:

Outpatient biopsy, only if lesion persists despite elimination of possible etiologic factors

GENERAL MEASURES:

• Eliminate habitual lip biting
• Correct ill fitting dental appliances
• Stop smoking and alcohol
• If dysplasia evident, remove lesion. Consider otolaryngologist referral.
• Some small lesions may respond to cryosurgery
• Beta-carotene may cause partial regression (experimental)
• For hairy tongue: Tongue brushing

SURGICAL MEASURES:

• Excision is the treatment of choice for lesions exhibiting dysplasia or malignant transformation

ACTIVITY:

Full

DIET:

Regular

PATIENT EDUCATION:

• If biopsy negative, stress importance of periodic and careful followup
• Aid the patient in discontinuing tobacco and/or alcohol use. Referral to support groups, recommendations for stop smoking programs, etc.

MEDICATIONS

DRUG(S) OF CHOICE:

• Hairy leukoplakia
• Acyclovir 2-4 gm/day systemically is effective, but the lesions recur when the treatment is stopped
• Topical retinoids
• Topical podophyllin 25% resin applied twice, one week apart, but the bad taste is poorly tolerated
• Leukoplakia
• isotretinoin (Accutane) 1-2 mg/kg/day may lead to temporary remission, but side effects are poorly tolerated

Contraindications: N/A
Precautions: N/A
Significant possible interactions: N/A

ALTERNATIVE DRUGS:

N/A

FOLLOW UP

PATIENT MONITORING:

Regular, close followup, even after successful treatment. Biopsy as needed.

PREVENTION/AVOIDANCE:

• Avoid tobacco, alcohol, habitual biting
• Provide well-fitting dentures

POSSIBLE COMPLICATIONS:

• Carcinoma
• New lesions may develop after treatment

EXPECTED COURSE AND PROGNOSIS:

• Curable if detected early
• 4-6% of initially benign lesions subsequently develop cancer
• More likely cancerous if on floor of mouth

MISCELLANEOUS

ASSOCIATED CONDITIONS:

• Leukokeratosis nicotina palati is rarely malignant
• HIV infection

AGE-RELATED FACTORS:

Pediatric: N/A
Geriatric: More common in elderly
Others: Rare before age 40

PREGNANCY:

N/A

SYNONYMS:

N/A

ICD-9-CM:

528.6 Leukoplakia of oral mucosa or tongue

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Medical Diagnosis » L » Leukoplakia, oral II