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See also in: Oral Mucosal Lesion
Other Resources UpToDate PubMed


See also in: Oral Mucosal Lesion
Contributors: Stephanie Diamantis MD, Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc
Other Resources UpToDate PubMed


Leukoplakia is a clinical term only and refers to a mucosal white plaque that does not represent any other known clinical or histopathologic entity; it is therefore a clinical diagnosis of exclusion. Frictional keratoses have a specific etiology and are therefore not considered to be leukoplakias. Leukoplakia is a common oral finding that can be a precursor of mucosal squamous cell carcinoma. It is more common in smokers, but that may be because white plaques in smokers tend to be biopsied more frequently. The risk factors for this condition are the same as those for squamous cell carcinoma, and malignant transformation to invasive carcinoma occurs in 6%-18% of patients.

All leukoplakias represent one of the following:
  1. Epithelial dysplasia, carcinoma in situ, or invasive carcinoma
  2. Hyperkeratosis of unknown etiology
In the older literature, the prevalence of dysplasia, carcinoma in situ, or invasive carcinoma (usually squamous cell carcinoma) was 10%-20%. However, more recent data suggest that this may be as high as 40%.

Leukoplakia is most commonly found in middle-aged or elderly men. Leukoplakia in women can also involve the vulva, usually in obese postmenopausal females.


K13.21 – Leukoplakia of oral mucosa, including tongue

274134003 – Leukoplakia

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Frictional keratoses, specifically morsicatio mucosae oris and benign alveolar ridge keratosis, are located on nonkeratinized areas that are readily traumatized and on the alveolar ridge, respectively, and have specific histopathologic findings.
  • Oral hairy leukoplakia is most frequently seen in human immunodeficiency virus (HIV) and autoimmune deficiency syndrome (AIDS) patients, and Epstein-Barr virus is present in the biopsy.
  • Lichen planus is usually bilateral, symmetric, and reticulated.
  • Candidiasis resolves with antifungal therapy.
  • Smokeless tobacco keratosis occurs where the tobacco is placed.
  • Nicotinic stomatitis occurs on the palate almost exclusively and is symmetric with red punctate areas.
  • Squamous cell carcinoma
  • Dyskeratosis congenita (these are true leukoplakias that develop in patients with this disease)
  • Leukoedema is diffuse, gray-white, and disappears on stretching.
  • White sponge nevus is an extremely rare oral condition with specific histopathologic findings.
  • Uremic stomatitis

Best Tests

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Management Pearls

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Last Updated:07/02/2020
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