How Erythroplakia Relates to Oral Cancer

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Erythroplakia is a condition of the mouth that most always contains abnormal cells, and is defined by the World Health Organization (WHO) as any lesion of the oral mucosa that presents a bright-red velvety plaque. This plaque cannot be classified either clinically or pathologically as any other recognizable infection.

According to the Oral Cancer Foundation, premalignant lesions such as erythroplakia are far less common than leukoplakia or white lesions, but have a greater chance of being dyplasia or malignant in nature. Although this premalignant condition affects 1 to 5 percent of adults 50 years or older, early diagnosis is key.

Causes and outcomes

The predominant cause of erythroplakia is the use of tobacco products, both smokeless and in cigarette form. Pipes, cigars and chewing tobacco can all play a part, along with alcohol, which naturally increases the risk of a cancerous development. Sometimes, however, long-term irritation from ill-fitting dentures or fractured teeth can be the culprit. Biological factors such as age and persistent viral infections (especially human papillomavirus, such as HPV 16) have been known to contribute as well.

Prevention and early diagnosis can only be achieved by visiting your dentist regularly. Your dentist is uniquely qualified to examine the entire oral cavity – including the tonsils, upper throat and areas outside your head and neck – to check for swelling, palpable nodes or similar growths. Ultimately, your dentist or dental hygienist will ask you about your habits and guide you on the steps you can take to improve your oral health.

Avoiding these risky habits will help to curb this premalignant condition, but if a suspicious lesion is found, identifying it earlier rather than later is important. Because most oral cancers are "squamous cell carcinomas" found in the mucosa or lining of the mouth, this early diagnosis – combined with timely and appropriate treatment – will reduce the chances of the abnormal cells becoming a malignant condition.

What to look for

Lesions or ulcers in the mouth are often a result of trauma, viruses and even genetic predisposition. These common mouth sores and lesions exist in roughly one third of the population, and usually subside within a week to 10 days. Along the way, you can promote the healing process with over-the-counter rinses like Colgate® Peroxyl® Mouth Sore. However, if you do see a distinctly red and velvety lesion that persists for longer than two weeks, it should be checked. Erythroplakia is most commonly found in the floor of the mouth, under the tongue, throat, soft palate ind inside the cheeks.

A screening by your dentist will include:

  • Thorough medical history and examination of your mouth, teeth, head and neck.
  • Review of chemical or lifestyle factors.
  • Biopsy, both brush and surgical.
  • Referral to an oral surgeon or other specialist for a follow-up.
  • Diagnostic imaging – X-rays, CT scan and the like.

This exam can help to determine if you indeed have erythroplakia and what the treatment recommendations will be. Your medical history, and especially habits that include alcohol and tobacco use, will help your dentist determine the next step. A preliminary step can be done in the dentist's office using a brush biopsy – a non-invasive method of collecting cells for further analysis. If the results show a positive result for dysplasia or other abnormalities, you'll be referred to a specialist for an excisional/incisional biopsy and similar testing.

Treatment

If biopsy results are positive, your treatment will ideally remove all the abnormal cells to prevent the lesion from transforming from a premalignancy to a malignancy. Keep in mind this condition can return in the same area, so careful monitoring for the recurrence is strongly advised. Of course, the cessation of habits like smoking and drinking are just as necessary, as are certain dietary improvements that directly lead to poor oral health.

Oral lesions are often a red flag for an underlying condition, or an indicator that your oral health needs tending to. Self-monitoring for oral changes, as well as regular preventive visits to your dentist, can catch problems in the early stages. Be aware of your role in this process, even as you enjoy your dental practioner's diligence, to maintain your oral and overall health.

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