Erythroplakia

Gastroenterology

Clinicals - History

Fact Explanation
Asymptomatic Some patients are asymptomatic and the initial lesions are painless. Asymptomatic
Some patients are asymptomatic and the initial lesions are painless.
Soreness of the mouth Patients complain of soreness of the mouth, burning sensation or metallic taste. Often the lesions bleed and present with hematemesis. Soreness of the mouth
Patients complain of soreness of the mouth, burning sensation or metallic taste. Often the lesions bleed and present with hematemesis.
Red colored oral lesions Some patients may notice the red velvety lesions themselves. Red colored oral lesions
Some patients may notice the red velvety lesions themselves.
Loose denture Loose denture rubs against the oral mucosa causing mucosal irritation and erythroplakia. Sharp edges of fractured tooth or ill fitting dental prosthesis can also cause erythroplakia. Loose denture
Loose denture rubs against the oral mucosa causing mucosal irritation and erythroplakia. Sharp edges of fractured tooth or ill fitting dental prosthesis can also cause erythroplakia.
Risk factors Tobacco smoking and chewing and excessive consumption of alcohol are recognized risk factors for the development of oral erythroplakia and cancers. Oral human papillomavirus infection and immunodeficiency increase the risk of erythroplakia. Poor oral hygiene, malposition of teeth and chronic candidiasis are relatively rare risk factors. Exposure to ultraviolet radiation is a risk factor for the development of erythroplakia of the lips.
Erythroplakia carries 85% risk of malignant transformation.
Risk factors
Tobacco smoking and chewing and excessive consumption of alcohol are recognized risk factors for the development of oral erythroplakia and cancers. Oral human papillomavirus infection and immunodeficiency increase the risk of erythroplakia. Poor oral hygiene, malposition of teeth and chronic candidiasis are relatively rare risk factors. Exposure to ultraviolet radiation is a risk factor for the development of erythroplakia of the lips.
Erythroplakia carries 85% risk of malignant transformation.

Clinicals - Examination

Fact Explanation
Examination of the oral cavity Beetle stains, poor oral hygiene and loose teeth should be looked for.
Mucosal lesions of erythroplakia appear as bright red velvety plaques with well defined margins. Surrounding mucosa appears normal. Oral lesions are commonly seen in the floor of the mouth, buccal mucosa, tongue and in the soft palate. These lesions cannot be wiped off.
Examination of the oral cavity
Beetle stains, poor oral hygiene and loose teeth should be looked for.
Mucosal lesions of erythroplakia appear as bright red velvety plaques with well defined margins. Surrounding mucosa appears normal. Oral lesions are commonly seen in the floor of the mouth, buccal mucosa, tongue and in the soft palate. These lesions cannot be wiped off.
Nicotine stains Patients who smoke tobacco have nicotine stains on their hands. Nicotine stains
Patients who smoke tobacco have nicotine stains on their hands.

Investigations - Diagnosis

Fact Explanation
Biopsy Biopsy of the suspicious lesions and histological examination is necessary for the diagnosis. Basal cell layer hyperplasia, haphazard arrangement of cells, increased mitotic activity and dysplastic changes (enlarged nuclei, increased nuclear to cytoplasmic ratio, prominent nucleoli and nuclear hyperchromasia) can be seen. Some lesions show carcinoma-in-situ and some progress to invasive carcinoma. Biopsy
Biopsy of the suspicious lesions and histological examination is necessary for the diagnosis. Basal cell layer hyperplasia, haphazard arrangement of cells, increased mitotic activity and dysplastic changes (enlarged nuclei, increased nuclear to cytoplasmic ratio, prominent nucleoli and nuclear hyperchromasia) can be seen. Some lesions show carcinoma-in-situ and some progress to invasive carcinoma.

Investigations - Management

Fact Explanation
Biopsy Patients with erythroplakia should be monitored regularly and malignant transformation should be diagnosed and treated early. Biopsy
Patients with erythroplakia should be monitored regularly and malignant transformation should be diagnosed and treated early.
Three-dimensional optical coherence tomography (OCT) OCT is a non-invasive test, which is useful in estimating the height of the epithelium. In erythroplakia height of the epithelium is increased due to high mitotic index and basement membrane cell hypertrophy. Loss of basement membrane integrity, and subepithelial invasion of tumor cells can also be detected. Three-dimensional optical coherence tomography (OCT)
OCT is a non-invasive test, which is useful in estimating the height of the epithelium. In erythroplakia height of the epithelium is increased due to high mitotic index and basement membrane cell hypertrophy. Loss of basement membrane integrity, and subepithelial invasion of tumor cells can also be detected.

Management - Supportive

Fact Explanation
Health education Public awareness should be raised regarding the harmful effects of tobacco and alcohol use. Use of lip sunscreen during outdoor activities help in reducing the risk of lip erythroplakia.
Patients should be stressed about the importance of regular and close follow up even after surgical excision of the lesion, because erythroplakia has significantly high risk of malignant transformation.
Health education
Public awareness should be raised regarding the harmful effects of tobacco and alcohol use. Use of lip sunscreen during outdoor activities help in reducing the risk of lip erythroplakia.
Patients should be stressed about the importance of regular and close follow up even after surgical excision of the lesion, because erythroplakia has significantly high risk of malignant transformation.
Correction of precipitating causes If the underlying etiology for erythroplakia is reversible, correction of the etiology will reverse erythroplakia in most of the patients. Ill fitting denture, loose tooth, fractured tooth, consumption of alcohol and tobacco smoking are correctable causes.
Patients should be followed up with biopsy after correction of the etiology to diagnose or to exclude the resolution of the lesions.
Correction of precipitating causes
If the underlying etiology for erythroplakia is reversible, correction of the etiology will reverse erythroplakia in most of the patients. Ill fitting denture, loose tooth, fractured tooth, consumption of alcohol and tobacco smoking are correctable causes.
Patients should be followed up with biopsy after correction of the etiology to diagnose or to exclude the resolution of the lesions.

Management - Specific

Fact Explanation
Excision of the lesion Surgical excision of the lesion is the definitive mode of treatment. Excision of the lesion
Surgical excision of the lesion is the definitive mode of treatment.
Dietary supplementation Dietary supplementation of vitamin A and beta-carotene is proven to regress the lesions and to prevent the occurrence of erythroplakia. Dietary supplementation
Dietary supplementation of vitamin A and beta-carotene is proven to regress the lesions and to prevent the occurrence of erythroplakia.

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