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Erythroplakia / Erythroplasia
Definition

Erythroplakia (Greek, “flat red area”) is defined as a fiery
red patch that cannot be characterised either clinically or
pathologically as any other definable lesion.

These may appear as a bright red, smooth, velvety,
granular or nodular lesions often with a well-defined
margins adjacent to normal looking mucosa and are usually
asymptomatic.

The soft palate, the floor of mouth, the ventral surface of
tongue and the retro-molar area are the most common
sites of involvement.

Erythroplakia is more common among middle aged to
elderly persons and, especially among men.  It is less
common than
leukoplakia.

The prevalence of these lesions range from 0.02 - 0.83%
in different regions.

Ætiology

The risk factors for erythroplakia are the same as for oral
squamous cell carcinoma
.

Diagnosis

Erythroplakia is seldom multi-centric and rarely covers
extensive areas of the mouth.  It is soft on palpation and
does not become
indurated until an invasive carcinoma
develops in it.

It is often asymptomatic, although some patients may
complain of a sore, burning or metallic sensation.

Oral erythroplakia has the highest risk of malignant
transformation
compared to all other mucosal lesions ie
Most potentially malignant of all oral mucosal lesions.

All
erythroplakias should be viewed with extreme clinical
suspicion for
malignancy, as they are more likely to
harbour
histological foci of severe dysplasia, carcinoma in-
situ
(CIS) or micro-invasive cancer.

The incidence of
severe dysplasia or carcinoma in these
lesions is very high (80 – 90%) and biopsy is mandatory.  
Areas of
erythroplakia may also co-exist with leukoplakia
in so-called “
mixed” or “speckled” lesions (erythro-
leukoplakia
).

Care must be taken to obtain a representative biopsy
specimen in such cases, with sampling of multiple areas
within the lesion, as
carcinoma may be present only focally.


Bond's Book of Oral Diseases, 4th Edition

CancerHelp UK


International Agency for Research on Cancer / World Health Organisation


Useful Articles:

Dental Update 1999.  Orofacial Disease.  Update for the Dental Clinical Team.  4.
Red, Brown, Black & Blueish Lesions

British Medical Journal 2000.  ABC of Oral Health - Swellings & Red, White &
Pigmented Lesions

British Medical Journal 2000.  ABC of Oral Health.  Oral Cancer

Journal of Dental Education 2002.  Systematic Review of Randomized Trials for
the Treatment of Oral Leukoplakia

CA Cancer J Clin 2002.  Oral Cancer and Pre-cancerous Lesions

Critical Reviews in Oral Biology & Medicine 2003.  Prognosis of Oral Pre-malignant
Lesions - Significance of Clinical, Histopathological & Molecular Biological
Characteristics

J Can Dent Assoc 2004.  Pigmented Lesions of the Oral Cavity. Review,
Differential Diagnosis and Case Presentations

Oral Oncology 2004.  Oral Erythroplakia - A Review

Red & Mixed Red-White Lesions.  Clinical Stomatology Conference.  September
2007

ENT News 2008 - What is the Risk of a Red or White Lesions in the Mouth Being
Malignant?

MJA 2009.  Clinical Update.  Oral White Lesions - Pitfalls of Diagnosis

Head Neck 2009.  Treatment & Follow-up of Oral Dysplasia - A Systematic
Review & Meta-Analysis

Histo-pathological examination.


Differential Diagnosis

The following conditions should be considered before making a diagnosis of
erythroplakia:



Management / Treatment

Management of oral erythroplakia focuses on the prevention of malignant
transformation
and early detection of occult malignancy.

Persons with
erythroplakia should be advised to stop tobacco / alcohol habits and
should be encouraged to take a diet rich in vegetables and fruits (
anti-oxidants).

In view of the
high malignant potential of these lesions, the recommended
treatment is surgical excision, including laser.  However, even after surgical
excision, the recurrences and development of
malignancy at the same site are
high.  In view of this, long-term follow-up is essential even after surgical removal.
Photos of Oral Erythroplakia
Last Updated 16th January 2014