Hairy leukoplakia:

tends to occur on lateral side of tongue; cannot be scraped off like thrush;

related to Epstein-Barr virus; in immunocompromised pt

Hyperplasia of squamous mucosa, No dysplasia

often biopsied to rule out carcinoma

Erythroplakia:

vascularized leukoplakia

more dysplastic; premalignant --> SCC

The correct statements regarding erythroplakia and leukoplakia are:

• Should be referred urgently to secondary care for further investigation
• Will show severe dysplasia on biopsy in a high proportion of cases (This is particularly true for erythroplakia).

🩺 Explanation of Oral Lesions

Erythroplakia and leukoplakia are both types of Potentially Malignant Disorders (PMDs) of the oral mucosa.

Erythroplakia Characteristics

Erythroplakia (a persistent, velvety red patch that cannot be characterized as any other disease) is considered the highest-risk PMD for malignant transformation.

• Urgent Referral: Both erythroplakia and persistent, non-scrapable leukoplakia must be referred urgently to secondary care (Oral Surgery or Maxillofacial surgery) for assessment and definitive diagnosis via biopsy. Monitoring in primary care is inappropriate due to the high risk of cancer.
• Dysplasia Risk: Erythroplakia is notorious for its high malignant potential. Studies show that ≥90% or more of erythroplakia lesions, when biopsied, will show severe dysplasia or already be an invasive carcinoma.

Leukoplakia vs. Erythroplakia

• Prevalence: Leukoplakia (a white patch) is significantly more common than erythroplakia. Therefore, the statement that erythroplakia is more common is incorrect.