Erythroplakia is a condition with a high potential for turning cancerous that cannot be attributed to any traumatic, vascular or inflammatory cause. Read on to know all about this disorder, including its causes, symptoms, diagnosis and treatment.
It is a rare type of lesion or fiery red patch found in the mucosa of the mouth that could be an early warning sign of pre-cancerous or cancerous changes. The condition is often also known as Erythroplasia.
The condition is characterized by flat, distinct, elevated areas on the skin known as macules or fine-bordered plaques, which are the semi-hardened accumulation of fluids. The size of the lesions may vary between 1.5 cm and 4 cm. These oral sores generally have a soft and velvety texture that may begin to bleed on scraping. It rarely covers the extensive areas of mouth, and is usually restricted to the floor of the mouth, tongue and soft palate. Occasionally, Leukoplakia (a condition marked by thickened white patches on the tongue, cheeks, gums and the bottom of the mouth) can occur along with the red lesions for unknown reasons. In such cases, patients usually complain of a metallic taste in the mouth.
The exact etiology of the condition is still undetermined. The oral sores could be associated with carcinoma or cancer of the squamous cell – the primary cell found in the epidermis or outer layer of the skin. This form of skin cancer normally occurs in areas exposed to the sun. About 40% of the cases of Erythroplasia are malignant. However, the contributing factors of these oral premalignant lesions may include the following:
Picture 1 – Erythroplakia
- Excessive smoking
- Long-term alcohol consumption
- Lack of proper diet
- Poor dentition
- Infective agents
Physicians must have a high degree of clinical suspicion for malignancy in patients with innumerable bright red lesions in the oral mucosa. Doctors also have to evaluate the lifestyle of the affected individuals in order to link the condition with possible causes like frequent smoking, drinking or consumption of tobacco. A biopsy of the lesion is mandatory to confirm the presence of any precancerous or malignant condition in the mouth. Histopathological examination of the lesions provides the following diagnostic information:
Mild to severe epithelial dysplasia
The epithelial cells undergo abnormal multiplication and differentiation. Alternation in the size, shape and organization of the cells is the additional feature of dysplasia.
Several layers of the epithelium are replaced with dysplastic cells. This indicates the early form of mouth cancer, in which the tumor cells do not invade the surrounding tissues. In simple words, the cancer is localized in this stage and has not spread to the neighboring tissues.
Micro-invasive squamous cell carcinoma
The differentiated squamous cells signify a distinct type of oral mucosal cancer.
Erythroplakia Differential Diagnosis
The precancerous lesions are sometimes diagnosed after a gap of 1 to 2 weeks to check if the condition has subsided, or has aggravated. The symptoms of Erythroplasia are common to a number of pathological disorders. Due to this reason, a differential diagnosis is performed to eliminate the possibility of the presence of other conditions. Some of these ailments are:
- Acute atrophic candidiasis
- Erosive lichen planus
- Non-homogeneous leukoplakia
- Lupus erythematosus
- Actinic Keratosis
The severity of the epithelium dysplasia determines the treatment of the condition. While many health professionals take a wait-and-see approach to cases of leukoplasia, Erythroplakia may require immediate intervention. The malignant oral lesions need to be treated with greater care and urgency.
Picture 2 – Erythroplakia Image
Depending on the histological findings, healthcare specialists may opt for a complete surgical excision of the lesions, which could be an invasive and complex procedure. Oral sores are also the candidates for cryosurgical therapy – a method involving application of extreme cold with the aid of liquid nitrogen, argon or carbon dioxide snow to destroy the benign or cancerous lesions. In malignant cases, laser technology can either destroy or limit the spread of the tumor cells. A few physicians use combinations of radiation therapy and chemotherapy as adjuvant methods of treatment. Mild cases may respond to systemic or topical treatments with vitamin A or E.
There is no way to predict whether the condition will recur. Naturally, patients must make regular visits to doctors for long-term monitoring of the oral mucosa. However, the recurrence of this condition is common. Hence, regular follow-up should be an essential part of post-treatment check-up.