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Updated: Oct 4 2016


  • Introduction
    • Oral lesion caused by squamous hyperplasia
    • Characterized by areas of fixed white plaques of keratosis on the mucous membrane
    • May also be red (erythroplakia)
    • Most commonly seen at the vermilion border of lower lip
      • can be seen anywhere in the mouth
    • Causes:
      • EtOH
      • chewing tobacco
      • infection (HPV)
      • chronic irritation (e.g. poor-fitting dentures)
      • idiopathic
    • Classified as a premalignant lesion
      • transformation to oral squamous cancer occurs in 20%
  • Presentation
    • Physical exam
      • fixed white plaques on the mucous membrane
      • lesion cannot be scraped off
        • helps to distinguish this lesion from oral candidiasis
  • Evaluation
    • Differential diagnosis of an oral white plaque includes:
      • infectious (oral candidiasis, oral hairy leukoplakia, syphilitic leukoplakia)
      • normal variant (Fordyce' s granules)
      • traumatic (chemical burn, frictional keratosis)
      • immunologic (Lichen planus, lichenoid reaction)
      • neoplastic (oral squamous cell carcinoma)
      • idiopathic (leukoplakia)
    • Biopsy
      • must assess for oral cancer risk
  • Management
    • Focus on decreasing malignancy risk
      • smoking cessation
      • alcohol reduction
      • periodic review of lesion
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