Oral Leukoplakia on the Tongue Dorsum: an Uncommon Site of Occurrence of Oral Dysplasia

Background Leukoplakia and erythroplakia have always been considered potentially oral premalignant lesions each with varying degrees of concern. Many leukoplakias start out being considered keratoses of unknown significance and depending on their location and clinical presentation may be suspicious of harboring dysplasia within their borders. On surfaces of the tongue there can be variations of normal and many benign conditions which can mimic leukoplakia but may lead to suspicion of dysplasia at some point in their development. Case Summary Herein we present A 66-year-old female referred from the post-graduate prosthodontic clinic for evaluation of a 2 cm x 1 cm oval area of leukoplakia on the right posterior dorsal tongue. Her medical history confirmed that she was in reasonably good health managed only for elevated cholesterol. She reported that she had rough teeth in the past and several extractions in the maxillary right region of teeth that had fractured and reported occasional tongue biting. She denied history of smoking; however, occasionally drinks alcohol. On clinical examination, multiple white patches were noted on the dorsum of the tongue, with appearance consistent with hyperkeratosis due to chronic trauma. The leukoplakia on the right posterior dorsal tongue had a different appearance than the other areas, appearing corrugated with well-demarcated borders. Differential diagnosis included hyperkeratosis or possible acanthosis due to chronic trauma, hyperplastic candidiasis, and also dysplasia. A 4-mm punch biopsy was obtained and returned a diagnosis of moderate dysplasia. Conclusions The presence of a dysplastic lesion amongst other leukoplakias highlights the importance of thorough assessment for subtle differences in appearance when multiple lesions are present. The tongue is particularly susceptible to frictional changes which sometimes can lead to creation of keratotic regions and it is the clinician's responsibility to monitor these for any changes such as a more verrucous appearance, evidence of thickening or hyperplasia and corrugation or changes in the surface, which may be suggestive of early dysplasia. Management of this patient is continuing and a decision regarding wider excision of the entire lesion or laser ablation following additional geographic biopsies is being discussed. Leukoplakia and erythroplakia have always been considered potentially oral premalignant lesions each with varying degrees of concern. Many leukoplakias start out being considered keratoses of unknown significance and depending on their location and clinical presentation may be suspicious of harboring dysplasia within their borders. On surfaces of the tongue there can be variations of normal and many benign conditions which can mimic leukoplakia but may lead to suspicion of dysplasia at some point in their development. Herein we present A 66-year-old female referred from the post-graduate prosthodontic clinic for evaluation of a 2 cm x 1 cm oval area of leukoplakia on the right posterior dorsal tongue. Her medical history confirmed that she was in reasonably good health managed only for elevated cholesterol. She reported that she had rough teeth in the past and several extractions in the maxillary right region of teeth that had fractured and reported occasional tongue biting. She denied history of smoking; however, occasionally drinks alcohol. On clinical examination, multiple white patches were noted on the dorsum of the tongue, with appearance consistent with hyperkeratosis due to chronic trauma. The leukoplakia on the right posterior dorsal tongue had a different appearance than the other areas, appearing corrugated with well-demarcated borders. Differential diagnosis included hyperkeratosis or possible acanthosis due to chronic trauma, hyperplastic candidiasis, and also dysplasia. A 4-mm punch biopsy was obtained and returned a diagnosis of moderate dysplasia. The presence of a dysplastic lesion amongst other leukoplakias highlights the importance of thorough assessment for subtle differences in appearance when multiple lesions are present. The tongue is particularly susceptible to frictional changes which sometimes can lead to creation of keratotic regions and it is the clinician's responsibility to monitor these for any changes such as a more verrucous appearance, evidence of thickening or hyperplasia and corrugation or changes in the surface, which may be suggestive of early dysplasia. Management of this patient is continuing and a decision regarding wider excision of the entire lesion or laser ablation following additional geographic biopsies is being discussed.