Leukoplakia of palate

Leukoplakia of soft palate:

Is a whitish patch seen over the soft palate. This patch cannot be easily scrapped off.

Histology:

Leukoplakia demonstrates a thickened surface layer of parakeratin, sometimes orthokeratin. Basilar cells and keratinocytes in the lower portions of the epithelium usually show no evidence of dysplasia, besides a mild basilar hyperplasia, but about 10% of cases will be dysplastic and these have an elevated risk of malignant transformation.

Causative factors:

1. Smoking with the burning end of cigar inside the mouth

2. Tobacco chewing

3. Ill fitting dentures

4. Ultraviolet radiation

5. Presence of torus palatinus

6. Alcoholism

Predominantly common in males.

Leukoplakias begin as thin gray or gray/white plaques which may appear somewhat translucent, are sometimes fissured or wrinkled, and are typically soft and flat. They usually have sharply demarcated borders but occasionally blend gradually into normal mucosa..

When leukoplakia becomes red, it is known as erythroplakia. This is again a premalignant condition.

Staging of leukoplakia:

Phase I leukoplakia: is very thin patch of leukoplakia. The lesion is so thin that the underlying mucosa can be clearly seen. This stage of leukoplakia can regress in due course of time.

Phase II leukoplakia: These patches are homogeneous or thick, smooth, perhaps fissured. Leukoplakia can remain in this stage indefinitely or it can progress to phase III.

Phase III leukoplakia: These patches have surface irregularities of a nodular or granular nature, hence are referred to as granular or nodular leukoplakia. Phase III leukoplakias may become dysplastic, even invasive, with no change whatsoever in the clinical appearance.

Phase IV leukoplakia: Are also known as erythroleukoplakia, speckled leukoplakia, nonhomogeneous leukoplakia. These lesions are the ones that may undergo malignant transformation.