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Leukoplakia of the mucous membrane of the mouth and lips: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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Leukoplakia is a chronic disease of the oral mucosa and lips, which occurs as a result of an exogenous irritant and is characterized by keratinization of the mucosa. It occurs on all continents. Men get sick twice as often as women, at the age of 40-70 years.
Causes and pathogenesis of leukoplakia. Etiological factors include smoking, chewing and snuff tobacco, constant friction of dentures, alcohol and other constant irritants. Leukoplakia is a precancerous disease, preceding squamous cell carcinoma of the tongue and oral mucosa in 30% of patients. Gastrointestinal diseases are detected in 90% of patients with leukoplakia. Vitamin A deficiency, genetic factors, impaired permeability of cell membranes and transepithelial transport are considered important in the pathogenesis of development.
Symptoms of leukoplakia. Currently, flat, warty and erosive leukoplakia are distinguished. Some authors also include smokers' leukoplakia in this group.
Flat leukoplakia begins with hyperemia of the oral mucosa. Against this background, sharply delimited continuous foci of keratinization appear, resembling a film, grayish-white or grayish-brown in color, not rising above the skin level and not removed by scraping with a spatula. The surface of leukoplakia is dry and slightly rough. The lesions are clearly delimited, have jagged outlines. Due to the absence of infiltrate, no compaction is noted at the base of the keratinization areas upon palpation.
In warty leukoplakia, warty plaque growths of a milky white color are observed that rise above the level of the mucous membrane by 2-3 mm. This form often occurs against the background of a flat form and over time can transform into cancer.
Erosive leukoplakia mainly develops in foci of flat or warty leukoplakia. Erosions of various shapes and sizes are formed, which are located in places of frequent trauma. This form may be accompanied by painful sensations. An increase in the size of the erosion, the appearance of papillary growths and compactions of the lesion, bleeding with slight trauma to the erosion are a sign of malignancy.
In smokers' leukoplakia (Tappeiner's leukoplakia), continuous keratinization of the hard and adjacent areas of the soft palate is observed. The lesion is grayish-white or grayish-milky in color. Red dots are visible against this background, which are the gaping mouths of the excretory ducts of the salivary glands. The clinical picture of smokers' leukoplakia resolves quickly after stopping smoking. The course of leukoplakia is chronic.
Histopathology. Histologically, hyper- and parakeratosis and acanthotic growths are observed in the mucous membrane. In the underlying layer, vascular dilation and diffuse, predominantly lymphoid-cell infiltrate are observed. In warty and erosive forms, discomplexation of the cells of the spinous layer and cellular atypia are possible.
In smokers' leukoplakia, in addition to the above-described changes, parakeratosis, dilation of the excretory ducts and retention cysts of the salivary glands are detected.
Differential diagnosis. Leukoplakia should be distinguished from changes in the oral mucosa in lichen planus, lupus erythematosus, syphilitic papules, and soft leukoplakia.
Treatment of leukoplakia. First, in all cases of leukoplakia, a biopsy is necessary to exclude a malignant process. Cryodestruction or surgical excision is recommended. Positive results are noted with the use of beta-carotene and retinoids.
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