Erythroplakia

Erythroplakia is a flat red patch or lesion in the mouth that cannot be attributed to any other pathology. There are many other conditions that are similar in appearance and must be ruled out before a diagnosis of erythroplakia is made. Sometimes, a diagnosis is delayed for up to two weeks in order to see if the lesion spontaneously regresses on its own or if another cause can be found. Erythroplakia frequently is associated with dysplasia, and is thus a pre-cancerous lesion.

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Erythroplakia has an unknown cause but researchers presume it to be similar to the cause of squamous cell carcinoma. It is mostly found in elderly men around the ages of 65 - 74. It is commonly associated with smoking. The most common areas in the mouth where erythroplakia is found are the floor of the mouth, the tongue, and the soft palate. It appears as a red macule or plaque with well-demarcated borders. The texture is characterized as soft and velvety. An adjacent area of leukoplakia may be found along with the erythroplakia.

Microscopically, the tissue exhibits severe epithelial dysplasia, carcinoma-in-situ, or invasive squamous cell carcinoma in 90% of cases. There is an absence of keratin production and a reduced amount of epithelial cells. Since the underlying vascular structures are less hidden by tissue, erythroplakia appears red when viewed in a clinical setting.

Treatment involves biopsy of the lesion to identify extent of dysplasia. Complete excision of the lesion is sometimes advised depending on the histopathology found in the biopsy. Even in these cases, recurrence of the erythroplakia is common and, thus, long-term monitoring is needed.

References

• Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.