Erythroplakia
Erythroplakia is a precancerous condition characterized by soft, reddened patches that can appear on the floor of the mouth, the tongue, or the soft palate. This condition is particularly concerning due to its high rate of progression to cancer, making early detection crucial. Common risk factors include smoking, chewing tobacco, excessive alcohol consumption, and poor oral hygiene, with a notable association with human papillomavirus (HPV) as well.
The condition typically affects adults, especially those over sixty, and early symptoms may be minimal, often limited to the presence of the reddened patches themselves. Later symptoms can include bleeding, loose teeth, and changes in denture fit. Diagnosis involves screening by healthcare professionals, with a biopsy performed on suspicious lesions. Treatment usually requires surgical excision, and may also include radiation therapy, with a multidisciplinary approach to care.
Preventive measures, such as avoiding tobacco and alcohol, can help reduce the risk of developing erythroplakia and its associated complications. The five-year survival rate for affected individuals is approximately 69%, highlighting the importance of timely intervention and comprehensive care.
On this Page
Subject Terms
Erythroplakia
ALSO KNOWN AS: Oral cancer
RELATED CONDITIONS: Leukoplakia
DEFINITION: Erythroplakia is a precancerous soft, reddened patch found on the floor of the mouth, the tongue, or the soft palate.
Risk factors: Smoking, chewing tobacco, and excessive alcohol consumption, especially in combination, are known risk factors for erythroplakia. The use of smokeless tobacco and smoking marijuana are also potential risk factors. Contracting human papillomavirus (HPV) and having poor oral hygiene also contribute to the disease.
Etiology and the disease process: A history of smoking and use of alcohol may be an underlying cause of erythroplakia, but sometimes there is not an identifiable cause. This type of oral lesion has a high rate of developing cancer.
Incidence: Oral cancers usually appear in adults over sixty, with the average age of diagnosis being sixty-four. About 20 percent of cases occur in those under fifty-five. One out of 59 men and one in 139 women develop oral or oropharyngeal cancer. Over fifty-eight thousand new oral and pharynx cancer cases are diagnosed annually in the United States. The most commonly impacted organs include the tongue, tonsils, oropharynx, gums, mouth floor, and mouth.
Symptoms: There may be no early symptoms other than the reddened patch. Some lesions may be mixed with white patches (erythroleukoplakia). Later symptoms may include bleeding, loose teeth, and a change in the fit of dentures.
Screening and diagnosis: Early detection is important, and primary care physicians and dentists should perform screening exams. A biopsy is taken when a suspicious reddened patch is found in the mouth. This can be done by the primary care physician or by a head and neck specialist. Oral tumors are staged using the TNM system that describes the size of the primary tumor (T), the involvement of the regional lymph nodes (N), and whether the cancer has spread (metastasis, M). A numerical rating is assigned to each letter, and a stage grouping of 0–IV is assigned based on the ratings for the three categories.
Treatment and therapy: Excision of oral cancer is usually the necessary treatment, but radiation therapy may also be used with surgical treatment. The treatment team is and may include a head and neck surgeon, an oral and maxillofacial pathologist, a general pathologist, a radiation oncologist, a neuroradiologist, a reconstructive surgeon, a medical oncologist, a general dentist, an oral and maxillofacial surgeon, a maxillofacial prosthodontist, a dental hygienist, a nurse specialist, a speech pathologist, a nutritionist, and a tobacco cessation counselor.
Prognosis, prevention, and outcomes: The prognosis of oral cancers depends on the pathology findings and the extent of the lesion. A complete head and neck evaluation should be done to look for other cancers. As tobacco and alcohol use are known risk factors, avoiding or ceasing use will help prevent erythroplakia. Overall, the five-year survival rate for individuals with this cancer is 69 percent.
Bibliography
Lorenzo‐Pouso, Alejandro I., et al. "Critical Update, Systematic Review, and Meta‐analysis of Oral Erythroplakia as an Oral Potentially Malignant Disorder." Journal of Oral Pathology & Medicine, vol. 51, no. 7, 2022, pp. 585-593. doi.org/10.1111/jop.13304.
"Oral Cavity and Nasopharyngeal Cancers Screening (PDQ®)–Health Professional Version." National Cancer Insitute, 12 Apr. 2024, www.cancer.gov/types/head-and-neck/hp/oral-screening-pdq. Accessed 20 July 2024.
"Oral Cavity (Mouth) and Oropharyngeal (Throat) Cancer." American Cancer Society, www.cancer.org/cancer/types/oral-cavity-and-oropharyngeal-cancer.html. Accessed 20 July 2024.
Scully, C. "Challenges in Predicting Which Oral Mucosal Potentially Malignant Disease Will Progress to Neoplasia." Oral Diseases, vol. 20, no. 1, 2014, pp. 1–5. doi:10.1111/odi.12208.
"SEER Stat Fact Sheets: Oral Cavity and Pharynx Cancer." National Cancer Insitute, Surveillance Research Program, 2024, seer.cancer.gov/statfacts/html/oralcav.html. Accessed 20 July 2024.
Stoopler, Eric T., and Thomas P. Sollecito. Clinical Approaches to Oral Mucosal Disorders. Elsevier, 2014.
Tilakaratne, Wanninayake M., and Thomas George Kallarakkal. Clinicopathological Correlation of Oral Diseases. Springer, 2023.
"What Are Oral Cavity and Oropharyngeal Cancers?" American Cancer Society, 23 Mar. 2021, www.cancer.org/cancer/types/oral-cavity-and-oropharyngeal-cancer/about/what-is-oral-cavity-cancer.html. Accessed 20 July 2024.