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