White patches (leukoplakia)

What is leukoplakia?

Leukoplakia is a term ascribed to white patches of the oral mucosa that cannot be otherwise characterised (e.g. lichen planus, thrush, traumatic keratosis). The corresponding term for red patches is erythroplakia.

Why might leukoplakia (white patches) cause concern?

The key concern with such lesions is that they are not malignant or cancerous. Some can be identified as benign and innocuous clinically and monitored, but my threshold for biopsy in such cases is generally quite low. A biopsy will enable an accurate diagnosis and also exclude malignancy (cancer).

What does a biopsy involve?

Unless the lesion can be excised in its entirety then I will usually perform a small (incisional) biopsy. This will involve attending an outpatients appointment which should take no longer than 20 minutes including all paperwork. I will anaesthetise the area with a local injection of dental anaesthetic to numb the area in question. I will then painlessly remove a small representative portion of the lesion in question, sending this in formalin for analysis. Resorbable (dissolving) sutures will be placed.

What happens after my biopsy?

After your biopsy, you will be numb for a few hours, so I will usually advise against eating or drinking anything too hot. I will also recommend some simple over the counter (OTC) analgesia such as paracetamol or ibuprofen before the local anaesthetic wears off. The area should heal up uneventfully within a few days and I will see you back for a follow-up to check on your recovery and discuss the results of any histology reports.

This biopsy may demonstrate dysplasia. This is essentially pre-cancerous changes in the surface epithelium that may be low or high grade (also sometimes classed as mild, moderate or severe). In low grade dysplastic lesions, I will often recommend regular review and watchful waiting. In higher grade lesions, excision is recommended to ensure that the biopsy is representative of the lesion in its entirety (i.e. that there is no cancer “hidden” within the lesion) and also to enact treatment. This can be done with cautery or laser.

What if my biopsy shows cancer?

If I have a strong suspicion of oral cancer at the outset, I will make an urgent referral to colleagues who regularly undertake oral cancer treatment. As a substantiative consultant within a large NHS trust with a strong network, I am able to make a timely referral and help with laying the groundwork for appropriate investigations (e.g. biopsy, bloods, cross-sectional and/or plain film imaging), multidisciplinary team (MDT) discussion and ultimately your definitive treatment with an appro