Precancerous conditions of the mouth

Precancerous conditions of the mouth are changes to cells of the mouth that make them more likely to develop into cancer. These conditions are not yet cancer. But if they aren’t treated, there is a chance that these abnormal changes may become oral cancer.

The most common precancerous conditions of the mouth are leukoplakia and erythroplakia.

Leukoplakia

Leukoplakia is an abnormal white or grey area that develops on the tongue, the inside of the cheek, the gums or the floor of your mouth.

The presence of leukoplakia does not necessarily mean cancer. The risk of developing oral cancer depends on how different the abnormal cells are in shape, size and appearance compared to normal mouth cells. This abnormality is called dysplasia. The healthcare team closely watches people who have leukoplakia to look for signs of cancer.

Risk factors

The following risk factors increase your chance of developing leukoplakia:

  • smoking heavily
  • chewing tobacco
  • excessive alcohol use

Signs and symptoms

The signs and symptoms of leukoplakia include a whitish area or spots inside the mouth that cannot be easily scraped off.

Diagnosis

Your dentist or doctor will ask you about any symptoms you have and do a dental or oral exam. They may take a sample of cells from the abnormal area (called a biopsy) so they can be tested in a lab.

Treatments

There are no standard treatments for leukoplakia. It is managed by active surveillance. This means that your healthcare team watches your condition closely. They will use regular tests and exams to find any cancerous change early.

Because leukoplakia can develop into cancer, people with this condition should avoid known risk factors, such as using tobacco and drinking alcohol.

Erythroplakia

Erythroplakia is an abnormal red area or group of red spots that forms on the mucous membrane lining the mouth with no clear cause. The presence of erythroplakia does not necessarily mean cancer, but this precancerous condition has a high risk of developing into cancer. About 50% of these lesions develop into squamous cell carcinoma.

Risk factors

The following risk factors increase your chance of developing erythroplakia:

  • smoking heavily
  • chewing tobacco
  • excessive alcohol use

Signs and symptoms

The signs and symptoms of erythroplakia include a raised or smooth red area that often bleeds when scraped.

Diagnosis

Your dentist or doctor will ask you about any symptoms you have and do a dental or oral exam. They may take a sample of cells from the abnormal area (called a biopsy) so they can be tested in a lab.

Treatments

Treatment options for erythroplakia may include:

  • careful watching (active surveillance) and frequent follow-up
  • surgery
  • cryosurgery
  • laser surgery

Because erythroplakia can develop into cancer, people with this condition should avoid known risk factors, such as using tobacco and drinking alcohol.

Expert review and references

  • American Cancer Society. Oral Cavity and Oropharyngeal Cancer. 2016.
  • Cancer Research UK. The Mouth and Oropharynx. Cancer Research UK; 2016.
  • Mendenhall WM, Werning JW and Pfister DG. Treatment of head and neck cancer. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles & Practice of Oncology. 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011: 72:729-80.
  • Moutasim, K.A, Jenei, V., Sapienza, K., et al. Betel-derived alkaloid up-regulates keratinocyte alphavbeta6 integrin expression and promotes oral submucous fibrosis.. National Library of Medicine. The Journal of Pathology. National Library of Medicine; 2011. http://www.ncbi.nlm.nih.gov/sites/entrez.
  • Murchison, DF. Oral growths. Beers, M. H., & Berkow, R., (Eds.). Merck Manual Professional Edition. 2016.
  • NCI. What you need to know about oral cancer. National Cancer Institute. National Cancer Institute (NCI). Bethesda, MD: National Cancer Institute; 2009. http://www.cancer.gov.
  • Scully C. Medscape Reference: Cancers of the Oral Mucosa. 2016.
  • Wenig,B.M.. Squamous Cell Carcinoma of the Upper AerodigestiveTract: Precursors and Problematic Variants. Modern Pathology. Nature Publishing Group; 2002. http://www.nature.com/modpathol/index.html.

Medical disclaimer

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