Oral leukoplakia manifests differently in smokers and non-smokers

Joelma Sousa Lima,Décio Dos Santos Pinto Jr,Luciana Corrêa,Suzana Orsini Machado De Sousa

doi:10.1590/s1806-83242012005000024

Joelma Sousa Lima, Décio Dos Santos Pinto Jr + Show 2 more

Open Access

https://doi.org/10.1590/s1806-83242012005000024

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Abstract

Oral leukoplakias (OL) are potentially malignant lesions that are typically white in color. Smoking is considered a risk factor for developing OL, and dysplastic lesions are more prone to malignant transformation. The aim of this study was to describe the clinical features observed in dysplastic and non-dysplastic OL in both smokers and non-smokers. A total of 315 cases of OL were retrieved and separated into either dysplastic or non-dysplastic lesions, and these cases were further categorized as originating in either smokers or non-smokers. Frequencies of the type of OL lesion, with respect to whether the patients smoked, were established. The results demonstrated that 131 cases of OL were dysplastic (74 smokers and 57 non-smokers), and 184 were non-dysplastic (96 smokers and 88 non-smokers). For OL cases in smokers for which information about alcohol consumption was also available (84 cases), the results revealed no significant difference in the amount of dysplastic and non-dysplastic lesions. Dysplastic lesions were more frequent in male smokers and in non-smoking females. The median age of smokers with cases of OL was significantly lower than in non-smokers; the lowest median ages were observed for female smokers with dysplastic OL. The most frequent anatomical sites of dysplastic lesions were the floor of the mouth in smokers and the tongue in non-smokers. Dysplastic lesions in smokers were significantly smaller than non-dysplastic lesions in non-smokers. Being a male smoker, being female, being younger, and having smaller lesions were associated with dysplastic features in OL. These clinical data may be important for predicting OL malignant transformation.

Highlights

Oral leukoplakia (OL) is a clinical entity defined by the Word Health Organization (WHO) as “a white plaque of questionable risk having excluded known diseases or disorders that carry no increased risk for cancer.”[1]
Recent studies have demonstrated that the inclusion of benign alveolar ridge keratosis as a type of OL causes a deviation in the reported percentage of malignant transformation
When benign alveolar ridge keratosis is excluded from the OL group, the frequency of dysplasia transforming into squamous cell carcinoma increases from 18% to 25%

Summary

Introduction

Oral leukoplakia (OL) is a clinical entity defined by the Word Health Organization (WHO) as “a white plaque of questionable risk having excluded (other) known diseases or disorders that carry no increased risk for cancer.”[1]. Recent studies have demonstrated that the inclusion of benign alveolar ridge keratosis as a type of OL causes a deviation in the reported percentage of malignant transformation. When benign alveolar ridge keratosis is excluded from the OL group, the frequency of dysplasia transforming into squamous cell carcinoma increases from 18% to 25%.9. Differences in the rates of malignant transformation are attributed to variations in the criteria used to define OL, such as differences in ethnic and environmental factors.[9,10] Risk factors for malignant transformation of OL include being female, having a long duration of OL, having a lesion size greater than 200 mm[2], being a non-smoker, having a lesion located on the tongue or the floor of the mouth, having a lesion of a non-homogeneous type, presenting with dysplasia and developing DNA aneuploidy.[8,11] When benign alveolar ridge keratosis is excluded from the OL group, the frequency of dysplasia transforming into squamous cell carcinoma increases from 18% to 25%.9 Differences in the rates of malignant transformation are attributed to variations in the criteria used to define OL, such as differences in ethnic and environmental factors.[9,10] Risk factors for malignant transformation of OL include being female, having a long duration of OL, having a lesion size greater than 200 mm[2], being a non-smoker, having a lesion located on the tongue or the floor of the mouth, having a lesion of a non-homogeneous type, presenting with dysplasia and developing DNA aneuploidy.[8,11]

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