Erythroplakia

Erythroplakia (also known as "Erythroplasia"^[1]:734) is a flat red patch or lesion in the mouth^[2] that cannot be attributed to any other pathology.^[3]:805

A similar term is "erythroplasia", which has a papular appearance.^[4]

Diagnosis and associated conditions

There are many other conditions that are similar in appearance and must be ruled out before a diagnosis of erythroplakia is made. Sometimes, a diagnosis is delayed for up to two weeks in order to see if the lesion spontaneously regresses on its own or if another cause can be found. Erythroplakia frequently is associated with dysplasia, and is thus a precancerous lesion.

Causes

Erythroplakia has an unknown cause but researchers presume it to be similar to the cause of squamous cell carcinoma. Carcinoma is found in almost 40% of erythroplakia.^[5] It is mostly found in elderly men around the ages of 65 - 74. It is commonly associated with smoking.

Alcohol and tobacco use have been described as risk factors.^[6]

Presentation

The most common areas in the mouth where erythroplakia is found are the floor of the mouth, the tongue, and the soft palate. It appears as a red macule or plaque with well-demarcated borders. The texture is characterized as soft and velvety. An adjacent area of leukoplakia may be found along with the erythroplakia.

Microscopically, the tissue exhibits severe epithelial dysplasia, carcinoma-in-situ, or invasive squamous cell carcinoma in 90% of cases. There is an absence of keratin production and a reduced number of epithelial cells. Since the underlying vascular structures are less hidden by tissue, erythroplakia appears red when viewed in a clinical setting.

Treatment

Treatment involves biopsy of the lesion to identify extent of dysplasia. Complete excision of the lesion is sometimes advised depending on the histopathology found in the biopsy. Even in these cases, recurrence of the erythroplakia is common and, thus, long-term monitoring is needed.

References