Overview

What is leukoplakia?

Leukoplakia is a condition that creates white patches in your mouth. The patches don’t hurt but they don’t go away, even if you rub them. You may develop leukoplakia because something is irritating the inside of your mouth. Leukoplakia may become oral cancer, so your dentist may recommend you see a specialist to diagnose and treat it.

What are the types of leukoplakia?

There are two types of leukoplakia:

Homogeneous leukoplakia: Homogeneous leukoplakia may look like a flat white patch in your mouth. The patch surface may be smooth, wrinkled or have ridges. This leukoplakia is typically benign, meaning it usually doesn’t become oral cancer. It’s more common than non-homogeneous leukoplakia.
Non-homogeneous leukoplakia: Non-homogeneous leukoplakia may cause irregular or odd-shaped white or red patches in your mouth. The patches may be flat or have raised surfaces. Studies show that non-homogenous leukoplakia is seven times more likely to become cancerous than the homogenous type.

What are leukoplakia subtypes?

The two leukoplakia subtypes are:

Proliferative verrucous leukoplakia (PVL): Some studies suggest more than 60% of people with PVL develop oral cancer. PVL may look like small white patches in your mouth. The patches can grow on your tongue, gums, the soft tissue between your lips and gums, and tissue lining the inside of your cheeks. PVL patches can grow very quickly and may develop tiny lumps or bumps.
Oral hairy leukoplakia: This condition looks like its name — white hairy patches, often with folds so it looks like hair is growing out of the folds. These spots mostly happen on your tongue but might appear in other parts of your mouth. This leukoplakia type doesn’t become cancer. People with HIV/AIDS or Epstein-Barr virus often develop oral hairy leukoplakia.

Does leukoplakia always become oral cancer?

No, it doesn’t. Studies show less than 15% of people with leukoplakia develop oral cancer. Medical researchers are studying why and when leukoplakia may become cancer. For example, leukoplakia on your gums is less likely to become cancer than leukoplakia on your tongue or the floor of your mouth.

Not every white patch in your mouth will become cancer. Your healthcare provider will tell you what to expect if you have leukoplakia.

Is leukoplakia common?

Leukoplakia is relatively rare. It affects less than 5% of people worldwide.

Symptoms and Causes

What are the symptoms?

Leukoplakia symptoms are patches inside your mouth that don’t go away. The patches may:

Appear on your tongue, gums and the inside of your cheeks.
Look flat or slightly raised.
Be white, gray or white with tiny red dots.

What causes leukoplakia?

You can develop leukoplakia if something irritates tissue lining the inside of your mouth. For example, you may chew the inside of your cheeks or use dentures that don’t fit well.

Leukoplakia may also happen when certain genes mutate, or change. (Genes tell cells what to do, such as how fast they should grow or when they should die off to make room for new cells.) In leukoplakia, genetic mutations make mouth tissue cells multiply faster than normal, creating patches.

What are risk factors of leukoplakia?

The following activities increase your chances of developing leukoplakia:

Smoking or using chewing tobacco and smokeless tobacco.
Regularly drinking substantial amounts of beverages containing alcohol.
Having certain health conditions that affect your immune system, like Epstein-Barr virus or HIV.

Diagnosis and Tests

How is leukoplakia diagnosed?

A healthcare provider will diagnose leukoplakia by examining your mouth and any unusual white patches. They’ll try to find what’s causing your symptoms. For example, if you use dentures, your provider may make sure your dentures aren’t rubbing against your gums or the inside of your cheeks. Your provider may do biopsies and send a sample of your tissue to medical pathologists to examine under a microscope.

Should all suspected leukoplakia be biopsied?

Yes, they should. A biopsy is the only way to determine if you have leukoplakia that may become oral cancer.

Management and Treatment

How is leukoplakia treated?

Healthcare providers treat leukoplakia by removing the patches in your mouth. They may remove the patches with a scalpel. Other potential procedures include:

Using a laser to remove the patches.
Using light-activated cancer drugs (photodynamic therapy).
Using cryotherapy, which is extreme cold that freezes and kills abnormal cells and removes the patches.
Using an electrically heated needle or other instrument to remove the patches (electrocauterization).

Prevention

How can I prevent leukoplakia?

Because experts aren’t always sure what causes leukoplakia, you may not be able to prevent it. However, leukoplakia is linked to tobacco and alcohol use. You may lower your risk by:

Avoiding tobacco, including chewing tobacco and smokeless tobacco.
Limiting your intake of beverages containing alcohol. According to American Cancer Society guidelines, people who choose to drink beverages containing alcohol should limit their intake to no more than two drinks per day for men and people assigned male at birth and one drink per day for women and people assigned female at birth.

Outlook / Prognosis

Does leukoplakia come back (recur)?

Yes, it does. Studies suggest of leukoplakia comes back around 15% of the time after it’s removed.

Will leukoplakia go away on its own?

No, it won’t. Surgery to remove leukoplakia is the only way to make it go away.

Living With

When should I see my healthcare provider?

If you had surgery to remove leukoplakia, your provider may recommend you have regular follow-up appointments for several years. Providers typically recommend follow-up visits every six to 12 months. Visit a dentist every six months for routine dental care.

What questions should I ask my healthcare provider?

If you have leukoplakia, you may want to ask the following:

What treatment do you recommend?
Will treatment remove the patches?
What’s the chance that leukoplakia will become oral cancer?
What can I do to reduce my risk of oral cancer?

A note from Cleveland Clinic

Leukoplakia is a condition that creates white patches on your tongue, gums or the inside of your cheeks. The patches don’t hurt but they don’t go away. Leukoplakia may look harmless, but the condition may become oral cancer. Talk to your dentist if you notice white patches in your mouth. They’ll examine your mouth and, if needed, refer you to specialists for tests and treatment.

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Leukoplakia