Erythroplakia versus leukoplakia
Erythroplakia (a persistent, unexplained red patch) and leukoplakia (a persistent, unexplained white patch) are premalignant lesions, meaning changes in the mouth lining that can turn into cancer later.
Remember
A persistent unexplained red patch (erythroplakia) classically has the highest rate of malignant change of the oral potentially malignant disorders, so it needs urgent referral and biopsy. A persistent unexplained white patch needs specialist assessment and usually a biopsy, not reassurance.
Memory aid
red is the riskier colour
Use the colour of the patch to recall which of the two lesions carries the higher risk.
Some changes in the lining of the mouth can turn into cancer later, and colour separates the white patches from the red ones. Leukoplakia is a white patch or plaque that cannot be explained as any other disease. In practice it does not scrape off, and it persists once other specific causes have been considered.
Erythroplakia is the red counterpart: a bright red, velvety patch that cannot be attributed to any other condition. It is rarer than leukoplakia, but it is classically the one with the highest rate of progression to cancer. A mixed red and white patch is called erythroleukoplakia and is treated with the same caution.
Both may show dysplasia, meaning abnormal, disorganised cells that are not yet cancer. Some of these lesions progress to oral cancer. Reported averages for malignant transformation are about 30% for erythroplakia and nearer 10% for leukoplakia.
Early oral cancer and its premalignant lesions are often painless, so a person may notice nothing wrong, and that is why persistence matters. A persistent red patch needs urgent referral and a biopsy (a small sample examined under the microscope). NICE advises that a dentist who finds a red, or red and white, patch consistent with erythroplakia or erythroleukoplakia should consider an urgent suspected cancer referral. A persistent white patch also needs assessment by a specialist and usually a biopsy.
Key facts
- Leukoplakia
- a white patch or plaque in the mouth that cannot be attributed to any other disease.
- Erythroplakia
- a bright red, velvety patch in the mouth that cannot be explained by any other condition.
- Risk
- erythroplakia is rarer than leukoplakia but more serious, with a reported average malignant transformation of about 30% against nearer 10%.
- Bedside test
- leukoplakia does not scrape off, and a patch that scrapes away is not premalignant.
- Mixed lesion
- erythroleukoplakia is a mixed red and white patch and is treated with the same caution as erythroplakia.
- Referral
- a dentist who finds a red, or red and white, patch consistent with erythroplakia or erythroleukoplakia should consider an urgent suspected cancer referral.
- Painless
- early oral cancer and its premalignant lesions are often painless, so persistence is what matters.
Exam traps
- A white patch (leukoplakia) is also potentially malignant, but fewer of those lesions become cancerous: pooled figures are around 10% for it against about 30% for erythroplakia.
- A white patch that wipes off, leaving a red base, is oral candidiasis (a fungal infection) and not leukoplakia, and a patch that scrapes away is not premalignant.
- Nicotinic stomatitis, a white palate with red spots in a pipe smoker, is not premalignant in standard teaching.
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