27: Erythroplakia (erythroplasia)

Erythroplakia (erythroplasia)

INTRODUCTION

This chapter should be read along with Ch. 25.

Erythroplakia (from the Greek erythros = red and plakia = patch) is defined by the World Health Organization as ‘any lesion of the oral mucosa that presents as bright red velvety plaques which cannot be characterized clinically or pathologically as any other recognizable condition’. Erythroplastic lesions are well-defined velvety red plaques and are the oral lesions with the most severe dysplasia and greatest predilection to develop to carcinoma: at least 80% are severely dysplastic or frankly malignant.

INCIDENCE

Rare: mainly seen in older men. Erythroplakia is much less common than leukoplakia.

AGE

Occurs in the middle aged and the older patient.

GENDER

Occurs mostly in men.

GEOGRAPHIC

There is no known geographic incidence.

AETIOLOGY AND PATHOGENESIS

Unknown, but tobacco and alcohol or betel use may be involved (Ch. 25).

CLINICAL FEATURES

Red velvety patch of variable configuration, usually level with or depressed below surrounding mucosa, commonly seen on:

buccal mucosa (Fig. 27.1).

Fig. 27.1 Erythroplakia: usually a potentially malignant lesion. Carcinoma developed in this patient, who actually had long-standing lichen planus with lichenoid dysplasia

Some erythroplakias are associated with white patches, and are then termed speckled leukoplakia or erythroleukoplakia (Table 27.1).

Table 27.1

Regimens that might be helpful in managementof patient suspected of having erythroplakia

Regimen	Use in secondary care (severe oral involvement and/or extraoral involvement)
Likely to be beneficial	Excision
Unproven effectiveness	Photodynamic therapy Chemotherapy
Supportive	Cease tobacco, alcohol or betel use

DIAGNOSIS

A biopsy should be done to examine for epithelial dysplasia and carcinoma. The lesion should be differentiated from inflammatory and atrophic lesions (e.g. in deficiency anaemias, geographic tongue, lichen planus).

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Tags: Oral and Maxillofacial Medicine The Basis of Diagnosis and Treatment 3e

Jan 9, 2015 | Posted by mrzezo in Oral and Maxillofacial Pathology | Comments Off

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