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What Are Leukoplakia and Erythroplakia Lesions?

Medically Reviewed by Jabeen Begum, MD on November 24, 2021

Leukoplakia and erythroplakia, or the combined erythroleukoplakia, are types of lesions that appear in the mouth or throat. They may be white or red, and they can be flat or raised. Most don't cause any discomfort, though they can affect the voice if they are located on the vocal cords. While they are classified as possible precancerous lesions, most leukoplakia and erythroplakia lesions are harmless. 

Leukoplakia Lesions

The word leukoplakia means "white patch." It refers to any lesion that is in the mouth or throat with a whitish or grayish appearance and isn't easily identified as something else, such as an injury or infection. They tend to look like a slightly thickened area on the skin, similar to a callus. Your doctor or dentist can't remove them if they gently scrape at them during an examination.

Erythroplakia Lesions

Erythroplakia means "red patch" and refers to a lesion with a reddish appearance that doesn't have another obvious cause. They appear in the mouth or throat. They tend to be flat and have a velvety texture. They may have white spots on them. Some have a tendency to bleed easily. Your doctor or dentist cannot remove them by scraping at them.

What Are the Symptoms of Leukoplakia and Erythroplakia?

In many cases, erythroplakia and leukoplakia don't cause significant symptoms. You may not know you have a lesion until your dentist discovers it during a routine visit. You may also notice it while brushing or flossing your teeth.

Lesions can develop on the vocal cords. This can lead to voice changes that are noticeable. You may develop unexplained hoarseness or lose your voice completely. Symptoms may get worse over time.

What Causes Leukoplakia and Erythroplakia?

Many lesions in the mouth and throat are caused by irritations to sensitive tissue. Heavy alcohol and tobacco use are common causes of leukoplakia and erythroplakia lesions. Physical irritation from dental appliances like braces or dentures may also cause the lesions. Other lesions have no clear cause.

In other cases, leukoplakia and erythroplakia are evidence of cancer. The lesions can contain cancerous cells. They may also contain cells that have precancerous abnormalities called dysplasia. These cells can develop into cancer later.

What Is the Cancer Risk of Erythroplakia and Leukoplakia?

If you have either erythroplakia or leukoplakia, your doctor may first suggest waiting to see if the lesions go away on their own. If they don't go away within a few weeks, your doctor will need to do testing. The tests will determine if the lesions are cancerous or may become cancerous in the future.

Your doctor will need to perform a biopsy on the lesions. They will remove a sample of cells from the lesion or lesions and send them for analysis. A pathologist will examine them to see if they contain cancerous or precancerous cells.

Leukoplakia lesions are usually not cancerous. Only about 20% of leukoplakia lesions show signs of cancer or precancerous changes. The risk of cancer or dysplasia is higher if the lesion is under the tongue, as opposed to elsewhere in the mouth.

Erythroplakia lesions, while much less common, are more likely to be cancer or precancerous. Over 90% of these lesions are precancerous or cancerous.

Even if a lesion has some abnormal cells, that doesn't guarantee that it will develop into cancer. Some lesions never become malignant, despite having abnormal cells.

What Is the Treatment for Leukoplakia and Erythroplakia?

If a lesion is not causing symptoms and doesn't show any signs of cancer, you may not need any treatment. If your doctor suspects that the lesions are caused by alcohol or tobacco use, they may suggest you stop using them and see if the lesions clear up on their own. 

If the lesion is causing discomfort or it's affecting your voice, you can have it removed. Doctors can remove lesions using a laser-removal technique in their office. In some cases, surgery is required to remove the lesions. If the lesion is precancerous, your doctor may recommend removing it to prevent it from developing into cancer.

In the case of a cancer diagnosis, your doctor will discuss treatment options with you. You may need additional testing to determine if cancer has spread anywhere else in your body. Your doctor might send samples of the cancer cells for genomic testing to identify what type of cancer they are so you can have the best treatment.

Treatment for cancers of the mouth and throat often require surgery to remove any lesions or tumors. You may also need radiation, chemotherapy, or immunotherapy. Your doctor will help you design the most effective treatment plan.

If you have an unexplained lesion in your mouth or throat, call your doctor. They can help you decide what tests or treatment you might need. 

Show Sources

SOURCES: 

The American Cancer Society: "Tests for Oral Cavity and Oropharyngeal Cancers." "Treating Oral Cavity and Oropharyngeal Cancer." "What Are Oral Cavity and Oropharyngeal Cancers?"

The Oral Cancer Foundation: "Premalignant Lesions."

Weill Cornell Medicine, Sean Parker Institute for the Voice: "Leukoplakia and Erythroplakia."

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