Leukoplakia is a condition marked by the appearance of white or gray patches inside the mouth. These areas cannot be rubbed or scraped away, unlike some other oral conditions like thrush. While most cases of leukoplakia are not cancerous, the condition is considered precancerous. This means the cells have undergone changes that make them more likely to become malignant in the future.
What Leukoplakia Looks Like
The most common form of leukoplakia is homogenous leukoplakia, which presents as a uniformly white or grayish patch. These lesions are flat and thin, with a surface that may be smooth, wrinkled, or ridged. Common locations for these patches include the inside of the cheeks, the gums, the floor of the mouth, and on the tongue itself.
This type of leukoplakia is at a lower risk of developing into cancer. The patches are often painless and may go unnoticed for some time.
The development of these patches is a response to prolonged irritation, which triggers an excess production of keratin, the same protein that makes up hair and nails. This process creates the thickened, white appearance of the lesion. While associated with smokeless tobacco, any chronic irritant can potentially lead to this cellular change.
Identifying High-Risk Leukoplakia
Certain visual cues indicate a patch has a higher probability of becoming cancerous. These patches are called non-homogenous leukoplakia because their appearance is not uniform. They are more likely to contain precancerous or cancerous cells than their smooth, white counterparts.
One of the primary warning signs is the presence of red areas mixed within the white patch. This is referred to as speckled leukoplakia or erythroleukoplakia. The red areas, called erythroplakia, are often velvety in texture and bleed easily, suggesting a greater likelihood of malignancy.
Another high-risk feature is a change in the patch’s texture. Lesions that become thickened, hardened, or develop raised, wart-like projections are known as nodular or verrucous leukoplakia. These rough or bumpy surfaces indicate increased cellular activity and elevate the risk profile of the lesion.
The Diagnostic Process
It is impossible to determine whether a patch is cancerous by looking at it, making self-diagnosis unreliable. Any persistent white patch or unusual lesion in the mouth should be examined by a dentist or physician, as a professional evaluation is the only way to accurately diagnose the condition.
The diagnostic process begins with a visual examination of the mouth. The healthcare provider will also review your medical history and ask about lifestyle factors, such as tobacco and alcohol use.
If the lesion appears suspicious, the next step is a biopsy. This procedure involves removing a small sample of tissue from the patch for microscopic analysis by a pathologist. The biopsy can identify whether precancerous changes (dysplasia) or cancerous cells are present. An excisional biopsy may be performed to remove the entire lesion if it is small.