Leukoplakia appears as a white spot located in the oral mucosa and belongs to a group of disorders defined with the acronym PMD (Potentially Malignant Disorders).
It is therefore a sign to which particular attention must be paid as it constitutes a real risk of transformation in a malignant sense, towards the stage of oral carcinoma , the most common form of which is called squamous cell carcinoma.
The most frequent potentially malignant lesions of the oral cavity are divided into:

  • Leukoplakia , which is characterized by the presence of white plaques or spots;
  • Erythroplakia , characterized by bright red spots and is the lesion with the highest risk of evolution in a malignant sense;
  • Erythroleukoplakia , which instead manifests itself with the concomitance of both white and red spots;
  • Oral lichen planus , presents with white stripes of regular appearance and mainly localized on the cheeks, tongue and gums.

In this type of injury, color and shape play a key role in defining a diagnostic suspicion and setting up appropriate therapeutic strategies.
Returning to leukoplakia , it is a more frequent condition in males over 40 years of age and two types are recognized:

  • homogenous leukoplakia , in which the spots all have the same whitish pigmentation;
  • non-homogeneous leukoplakia , in which white spots alternate with red lesions (a characteristic situation of erythroleukoplakia). If the lesion has an irregular appearance it takes the name of verrucous leukoplakia.

The latter is a rather rare but aggressive form of leukoplakia , characterized by white lesions with jagged-looking margins. It is a lesion with a high risk of development in a malignant sense. Unlike simple leukoplakia, the most affected subjects are women between 40 and 50 years of age and both smoking and alcohol are not promoting factors in a malignant sense.
Let’s now analyze what are the main causes of leukoplakia.

What are the causes of leukoplakia
The main causes at the origin of the onset of oral leukoplakiathey must mainly be attributed to two common factors: smoking and alcohol, to which are added causes linked to certain types of viruses and bad behavior.
Smokers are 5 times more likely to develop oral cancer than the average population, and this is due to the combustion of tobacco and the substances mixed in it, which cause thermal irritation of the oral mucosa. On the other hand, those who habitually consume alcohol, associated with smoking, are about 30 times more likely to develop oral cancer than the average population.
Viruses potentially complicit in the development of leukoplakia are the Papilloma virus (HPV), the Epstein-Barr virus (EBV) and again thehepatitis C virus (HCV). Due to their effect, these viruses are called oncogenic viruses.
Bad habits in oral hygiene should be included among the possible causes of oral cancer , in fact bacterial proliferation creates the ideal conditions for states of chronic inflammation. This is believed to create a favorable premise for the onset of squamous cell carcinoma.
Genetic factors must also be taken into consideration, factors which in themselves have a low incidence in the onset of cancer, but which when associated with bad lifestyle habits (smoking, alcohol, poor oral hygiene) represent a high risk factor. .
Finally, more rare event, also the exposure to ultraviolet radiation (UVA – UVB) represents a promoting factor in particular for the onset of skin neoplasms, and therefore for squamous cell carcinoma of the lip.

Where oral carcinoma develops
most common The most common sites of onset are mainly concentrated in the tongue , floor of the mouth (below the tongue), cheeks , gums and palate . The lip represents a site where the carcinoma occurs less frequently.

A white spot in the oral mucosa is always synonymous with leukoplakia, and therefore with a precancerous lesion
.is the most common form of potentially malignant or pre-cancerous lesion, and as such must be subjected to careful medical evaluation to determine whether it can evolve into a real carcinoma (tumor), or if it is a lesion with similar but of a benign nature or if it can regress once the causes that determined its appearance have been removed.
Among the white spots on the oral mucosa, benign or temporary, forms caused by trauma of the mucosa are identified in particular, in the case of dental prostheses not adequately calibrated on the anatomical characteristics of the subject, or even by the structural characteristics of the teeth, especially in the case of alterations that make them too sharp, causing chronic injuries.

How to diagnose leukoplakia
Any lesion or alteration present on the oral mucosa should be carefully evaluated, as a possible factor of malignant disorder. In general, any lesion that does not regress spontaneously within 15-20 days should be subjected to careful medical evaluation to rule out whether it is dysplasia or carcinoma of the oral cavity.
The anamnesis, as seen previously, is based on the observation of the characteristics of the lesion (color, shape, irregularity of the margins) and if it causes pain, discomfort or changes in sensitivity (paraesthesia).
A first test investigates the cellular characteristics of the lesion, then a dye is applied directly on the lesion called toluidine blue, and this gives a primary indication to the doctor if the cells are being duplicated (a factor that suggests a risk in a malicious sense).
When the reaction of the dye is positive and the suspicion is stronger, a biopsy of the lesion is performed, then a small sample of tissues is taken and subjected to specific tests to confirm or not the malignancy of the lesion.

What are the therapies we have available
In general, leukoplakiaswith regular and well-localized margins they can be easily removed, but sometimes, depending on the case, the patient is sent back to check-ups on a regular basis to check that the situation does not degenerate into a malignant sense.
The patient is given precise indications to follow, such as the correct ways to take care of their oral hygiene or if they must undergo dental procedures to reduce the causes of chronic mucosal lesions.
If, on the other hand, the lesion has irregular margins, jagged edges, non-homogeneous colors, on the other hand, the most appropriate therapeutic option is that of surgery.
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