An Overview of Leukoplakia

What Every Tobacco User Should Know

In This Article

Leukoplakia is a mouth condition involving thickened white patches that cannot be scraped off on the mucous membranes (lining) of the mouth, gums, as well as on the tongue. It is most often caused by smoking or other types of tobacco use (such as using chewing tobacco). However, other types of irritants can cause leukoplakia as well. Some sources report that 80 percent of those with leukoplakia are smokers. In fact, several studies found that “the prevalence of smoking was as high as 82 to 100 percent in leukoplakia patients.”

If leukoplakia is mild, oftentimes it goes away without any intervention. But leukoplakia is considered a pre-cancerous condition, so it should not be taken lightly. Oral cancers oftentimes form near the patches of leukoplakia, and the leukoplakia lesions themselves may show indications of cancerous changes. 

Leukoplakia
Verywell / JR Bee 

Leukoplakia and Cancer

Most of the time, the white patches from leukoplakia are not considered cancerous and are therefore deemed benign. In some cases, though, it has been found that leukoplakia is an early sign of mouth cancer. In fact, according to the Cleveland Clinic Health Library, “ it can eventually develop into oral cancer. Within 15 years, about 3 to 17.5 percent of people with leukoplakia will develop squamous cell carcinoma, a common type of skin cancer.”

Cancers on the bottom of the mouth sometimes appear adjacent to leukoplakia in a condition called “speckled leukoplakia,” which involves white and red areas in the mouth. Speckled leukoplakia may be a sign that a person has the possibility of having cancer. 

Due to the risk of mouth cancer associated with leukoplakia, it’s advisable for anyone with unusual or ongoing changes in the mouth of any type to have it evaluated by their health care provider.

Oral Hairy Leukoplakia

One type of leukoplakia is called hairy leukoplakia. The name originated from the fuzzy white patches that look like folds or ridges that are often found on the sides of the tongue. Oral hairy leukoplakia is often mistaken for thrush mouth (a yeast infection of the mouth and gums). Unlike leukoplakia, thrush causes creamy white patches that can be wiped away. 

Hairy leukoplakia is common in people with a severely compromised immune system such as those with Epstein-Barr virus (EBV) or HIV/AIDS and other immunocompromised conditions.

Another major difference between hairy and regular leukoplakia is that hairy leukoplakia is not associated with a risk for cancer. Usually, medications can be prescribed for thrush that will stop the creamy white patches from growing. Hairy leukoplakia may be one of the very first signs of HIV.

Symptoms

The white patches of leukoplakia are normally found on the gums, inside the cheeks, under the tongue, or on the tongue itself. They may not be noticed initially. Other symptoms of leukoplakia may include:

  • grayish colored patches that cannot be wiped off
  • irregular textured or flat-textured patches in the mouth
  • areas in the mouth that are hardened or thickened
  • raised red lesions along with white patches (called speckled leukoplakia or erythroplakia) which may be pre-cancerous

When to Visit a Doctor

Although leukoplakia doesn’t normally cause any type of pain, it’s important to know when to visit the healthcare provider, because it could be a sign of something more serious. It’s important to see a healthcare provider when:

  • white patches in the mouth do not clear up on their own in two weeks
  • red or dark patches are noticed in the mouth
  • you observe any type of ongoing change in the mouth
  • you have ear pain when swallowing
  • there is an inability to open the mouth properly (that progressively worsens)

Causes

Long-term use of tobacco (smoking or chewing) or other irritants are the most common cause of leukoplakia, other causes may include:

  • dentures that do not fit correctly (or broken dentures)
  • an injury that occurs on the inside of the cheek (such as from accidentally biting the cheek)
  • broken or uneven teeth
  • long-term alcohol use
  • specific types of conditions in the body that cause inflammation
  • long-term use of chewing tobacco (from holding chewing tobacco against the cheeks)

Diagnosis

A diagnosis of leukoplakia usually involves:

  • an oral (mouth) examination by the health care provider
  • an attempt to try to wipe away the white patches (if they can be wiped off, it is likely not leukoplakia)
  • a thorough medical history to uncover certain risk factors (such as smoking or chewing tobacco)
  • ruling out other possible causes of white patches (such as thrush)
  • testing for early signs of cancer

A biopsy involves tissue removal from the body to examine it for a disease such as cancer.  Cancer testing for those with leukoplakia may include:

  • Oral brush biopsy: This is the removal of cells (to be tested for cancer) from the outer surface of the lesions using a small brush that spins.
  • Excisional biopsy: This is the surgical removal of tissue from the patch of leukoplakia (or in some instances the entire plaque) to test for cancer cells. The excisional biopsy is a more decisive method of testing for oral cancer than the oral brush biopsy.

After the excisional biopsy, if there is a positive result, the healthcare provider may make a referral to a specialist (an oral surgeon or an ear/nose/throat specialist) for oral cancer treatment. If the leukoplakia patch was very small and it was completely removed by the excisional biopsy, no further treatment may be needed other than ongoing observation.

Treatment

Treatment of leukoplakia is most effective after early diagnosis. Regular follow-up visits to the health care provider are vital, as is learning to thoroughly and regularly perform self-inspections of the mouth.

Usually, removing the source of the irritation (smoking, chewing tobacco, or excessive alcohol use) will be enough to cure the condition. 

However, if there is a positive biopsy result, further treatment is necessary. This may include one (or more) of several options.

  • If the leukoplakia is caused by a dental problem, a referral will be made to a dentist for correction of the ill-fitting dentures, jagged tooth, or other underlying cause.
  • Your doctor will call for the immediate removal of all leukoplakia to stop the spread of the cancer by using a laser, scalpel, or a cold freeze method with a probe (called a cryoprobe).
  • You will need regular follow-up visits to check for recurring symptoms of leukoplakia (which are common).
  • You may be prescribed an anti-viral medication if the diagnosis is hairy leukoplakia.

Keep in mind that even after leukoplakia patches are removed, there is still an increased risk of oral cancer.

A Word From Verywell

Although it’s important not to panic about the impending risk of oral cancer when you have leukoplakia, the risk factors should be addressed as soon as possible such as quitting smoking, chewing tobacco, drinking or exposure to other irritants (such as e-cigarettes). This is a condition that may be easy for some people to ignore, perhaps as something as common as a canker sore. However, it is not always harmless. Leukoplakia is often a warning sign, signaling that a person should make some healthy lifestyle adjustments. At its worst, it is a serious condition that requires immediate medical treatment.

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