Updated: 10/4/2016


Review Topic
  • Fixed white keratotic plaque on underside of tongueOral 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%
  • Physical exam
    • fixed white plaques on the mucous membrane
    • lesion cannot be scraped off
      • helps to distinguish this lesion from oral candidiasis
  • 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
  • Focus on decreasing malignancy risk
    • smoking cessation
    • alcohol reduction
    • periodic review of lesion

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