Leukoplakia of Oral Mucosa: Classification

Leukoplakia is defined as a white, nonwipeable patch of the mucosa that cannot be assigned to any other disease. Synopsis of the classification of oral precursor lesions.

WHO 2005:Dysplasia Ljubljana classification squamous intraepithelial lesions (SIL). Squamous intraepithelial neoplasia (SIN). Squamous intraepithelial neoplasia (SIN) reduced
SquamousHyperplasia Squamous (simple)hyperplasia – – – –
MinorDysplasia Basal and parabasal hyperplasia SIN I SIN: low risk
Moderate grade dysplasia Atypical hyperplasia(risk epithelium) SIN II SIN: high risk
High grade dysplasia SIN III SIN: high risk
Carcinoma in situ Carcinoma in situ SIN III SIN: high risk
Invasive carcinoma

White mucosal changes:

Clinic Localization/age/sex Diagnosis Etiology
Whitish, not wipeable, Wickham striae;extraoral (“outside the mouth”): reddish papules (“nodules”)
  • Cheek 80%, lips, tongue
  • <30 years
  • More women than men
  • Lichen (ruber)planus
unexplained
White, strippable, velvety coatings;mucosa underneath reddened, slightly bleeding
  • Cheek, palate,tongue
  • Candidiasis (thrush)
Candida albicanswith reduced general condition:antibiosis,diabetes, immunodeficiencies.
Whitish, lentil-sized, possibly striate keratinization;extraoral: keratinizing papules
  • Cheek, tongue, gingiva, palate.
  • Dyskeratosis follicularis(Darier’s disease); autosomal dominant inheritance.
Rare keratinization anomalywith irregular inheritance.
Erythema (skin redness) disc-shaped raised with central dent, white radial streaks, small ulcers (ulcers), possibly healing in white scars
  • Lips, cheek, tongue, palate;
  • Extraoral: v. a. “butterfly erythema” of the midface.
  • 20-40 years;
  • Women
  • Discoid lupus erythematosus (DLE)
  • Systemic lupus erythematosus (SLE)
autoimmune
White stain, not wipeable, barely raised
  • Cheek, lip mucosa;
  • More men than women
  • Mechanically irritativeLeukoplakia (pachyderma).
Hyperkeratosis due to stress -z. E.g. sharp edges
Field pavement cobblestone,whitish with central red dots
  • Palate
  • Elderly patients
  • Smokers
  • Leukokeratosis nicotinica palati (leukokeratosis of the smoker).
Tobacco condensates
Whitish, cannot be wiped away, “hair-like “rippled or wrinkled, longitudinally striped, blurred borders
  • Tongue margin
Epstein-Barr virus in AIDS
Spot or area, white, flat, slightly raised, cannot be wiped away, sharply defined,surface smooth and homogeneous
  • Cheek mucosa retroangular, floor of mouth,sublingual space, alveolar process (portion of the jaw where the dental compartments = alveoli are located).
  • Idiopathic leukoplakia
idiopathic
Spot or area, white, mottled or spotted, cannot be wiped away, rough surface, nodular or warty elevations
  • Usually from 40 years
  • More men than women
  • Verrucous leukoplakia
Cofactors:tobacco,alcohol,syphilis,vitamin deficiency,chronic candidiasis.
Spot or area white,mottled or spotted,cannot be wiped away,rough surface,blurred borders,reddish erosive lesions
  • Erosive leukoplakia
MechanicalIrritation