Leukoplakia of the mucous membrane of the mouth and lips: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Leukoplakia is a chronic disease of the mucous membrane of the mouth and lips, resulting from an exogenous stimulus, and characterized by keratinization of the mucous membrane. It occurs on all continents. Men are sick 2 times more often than women, at the age of 40-70 years.
Causes and pathogenesis of leukoplakia. Etiological factors are smoking, the use of chewing and snuff, constant friction of dentures, alcohol and other constant irritants. Leukoplakia is a precancerous disease, in 30% of patients the preceding squamous cell carcinoma of the tongue and oral mucosa. In 90% of patients with leukoplakia, gastrointestinal diseases are detected. An important role in the pathogenesis of development is attributed to vitamin A deficiency, genetic factors, impaired permeability of cell membranes and transepithelial transport.
Symptoms of leukoplakia. At present, flat, erectile and erosive leukoplakia are isolated. Some authors in this group also include leukoplakia of smokers.
Flat leukoplakia begins with hyperemia of the oral mucosa. Against this background, there are sharply delineated solid keratinized foci resembling a film, grayish-white or grayish-brown, not rising above the level of the skin and not being removed by scraping with a spatula. The surface of the leukoplakia is dry and slightly rough. Foci of lesion are clearly delineated, they have dentate outlines. In connection with the absence of infiltration during palpation of the seals in the base of the sites of keratinization is not noted.
With verrocus leukoplakia, warty-looking plaque growths of milky-white color rise to 2-3 mm above the level of the mucous membrane. This form often arises against a background of a flat shape and can eventually transform into cancer.
Erosive leukoplakia mainly develops in the foci of flat or verruzic leukoplakia. Formed erosion of various forms and sizes, which are located in places of frequent traumatization. This form can be accompanied by pain. The increase in erosion, the appearance of papillary growth and compaction of the lesion, bleeding with slight trauma to erosion are a sign of malignancy.
With leukoplakia smokers (leucoplakia Tappeynera) there is a continuous keratinization of hard and adjacent areas of the soft palate. The lesion has a grayish-white or grayish-milky color. Against this background, red dots are visible, representing yawning mouths of the excretory ducts of the salivary glands. The clinical picture of the leukoplakia of smokers is resolved quickly after smoking cessation. The course of leukoplakia is chronic.
Histopathology. Histologically, the mucous membrane shows hyper- and parakeratosis and acanthotic growths. In the underlying layer, vasodilation, diffuse, predominantly lymphoid-cellular infiltrate, is observed. With verrucous and erosive forms, discomplexation of cells of the spiny layer and cellular atypia are possible.
With leukoplakia smokers, in addition to the above-described changes, parakeratosis, dilatation of the excretory ducts and retention cysts of the salivary glands are revealed.
Differential diagnosis. Leukoplakia should be distinguished from changes in the oral mucosa with red flat lice, lupus erythematosus, syphilitic papules, mild leukoplakia.
Treatment of leukoplakia. First, in all cases of leukoplakia, a biopsy is necessary to exclude the malignant process. Cryodestruction or surgical excision is recommended. Positive results are noted with the use of beta-carotene and retinoids.
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