The diagnosis of leukoplakia of the oral mucosa is initially made on the basis of the patient’s history and clinical examination. Reliable interpretation can only be made on the basis of a biopsy (tissue sample). Note: All leukoplakias that persist for several weeks after removal of triggering factors must be clarified by biopsy.
1st order laboratory parameters – obligatory laboratory tests.
- Biopsy – complete diagnostic excision (surgical removal of tissue) if incisional biopsy (gold standard) is not representative of the entire lesion.
- Brush biopsy (brush biopsy) as an alternative to punch biopsy when it is not feasible.
- For follow-up of lesions without indication for biopsy but with residual uncertainty.
- For obtaining middle and deeper cell layers.
- DNA cytometry
- CDx procedure (computer-assisted diagnostics).
Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification.
- Intravital staining with toluidine blue.
- In justified individual cases
- Not a biopsy substitute
- Exfoliative cytology – should not be used because it only detects superficial cell layers, which means that malignancy (malignancy) of a lesion cannot be excluded with certainty.
- Genetic testing – used to predict malignant (malignant) transformation:
- No “markers” for reliable prediction.
- DNA ploidy
- Loss of heterozygosity (genetic variability).
Histologic (fine tissue) features of leukoplakia:
| Epithelial hyperplasia | Epithelial dysplasia (deviation of tissue structure from normal) |
| Hyperkeratosis | Dyskeratosis |
| Orthokeratosis | Basal cell hyperplasia |
| Parakeratosis | Cell polymorphism |
| Acanthosis | Multiplication of mitoses |
| Disruption of epithelial stratification |
