OMFS-0106: Homogeneous white patch of the buccal mucosa

§Chief complaint

White patch inside the cheek noticed by the dentist

§Medical & dental history

01Smokes 15 cigarettes daily for 25 years
02No systemic illness
03Regular attender
04No cheek-biting habit reported

§Clinical examination

01Well-demarcated homogeneous white plaque 20 x 12 mm on the right buccal mucosa
02Does not rub off with gauze
03Surface smooth, no induration, no ulceration
04No cervical lymphadenopathy

§ figuresFigures (3)

Leukoplakia — clinical image: Photo taken of patient, who will remain anonymous, treated at the University of Tennessee Health Science Center: College of Dentistry in Memphis, Tennessee. The lesion is an example of leukoplakia. Biopsy was going to be — Fig. 1Photo taken of patient, who will remain anonymous, treated at the University of Tennessee Health Science Center: College of Dentistry in Memphis, Tennessee. The lesion is an example of leukoplakia. Biopsy was going to be
“Leukoplakia02-04-06” · Photo uploaded by: dozenist. · CC BY-SA 3.0 · Wikimedia Commons

Leukoplakia — clinical image: These images are part of the 2013 publication from the NIH "Detecting Oral Cancer: A Guide for Health Care Professionals". Available on the 15/7/14 at https://www.nidcr.nih.gov/oralhealth/topics/oralcancer/detectingoralc — Fig. 2These images are part of the 2013 publication from the NIH "Detecting Oral Cancer: A Guide for Health Care Professionals". Available on the 15/7/14 at https://www.nidcr.nih.gov/oralhealth/topics/oralcancer/detectingoralc
“NIH DOC 17 Leukoplakia” · BodyParts3D/Anatomography · Public domain · Wikimedia Commons

Leukoplakia — clinical image: Title Leukoplakia Description Gum damage caused by leukoplakia (with white patches shown). Leukoplakia are patches on the tongue, in the mouth, or on the inside of the cheek that occur in response to long-term irritation — Fig. 3Title Leukoplakia Description Gum damage caused by leukoplakia (with white patches shown). Leukoplakia are patches on the tongue, in the mouth, or on the inside of the cheek that occur in response to long-term irritation
“Leukoplakia” · Unknown photographer · Public domain · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Leukoplakia figures pending faculty review.

§Differential diagnosis

LeukoplakiaDiagnosis of exclusion; does not wipe off, no other cause

Frictional keratosisRelated to a sharp cusp or habit, resolves when cause removed

Oral lichen planusBilateral, Wickham striae

Pseudomembranous candidiasisWipes off leaving erythema

§Final diagnosis

Oral leukoplakia, homogeneous type, with mild epithelial dysplasia

The patch cannot be wiped off, has no identifiable frictional cause, and is unilateral — excluding candidiasis and lichen planus. Leukoplakia is a clinical diagnosis of exclusion; biopsy grades the dysplasia and drives follow-up intensity.

§Investigations

01Incisional biopsy of the most suspicious area
02Smoking cessation referral and 2-week re-review after removal of possible irritants
03Photographic documentation with a scale

§Treatment plan

01Tobacco cessation counselling
02Surgical excision or laser ablation of the dysplastic area
03Structured surveillance every 3-6 months

§Surgical procedure

01CO2 laser vaporisation after excisional biopsy of the thickest area

§Histopathology report

Hyperkeratotic squamous epithelium with basal cell hyperplasia, mild nuclear hyperchromatism confined to the lower third. Mild epithelial dysplasia. No invasion.

§Follow-up & outcome

01Patch resolved after 4 months of abstinence and laser treatment
026-monthly review; no recurrence at 2 years

§Clinical pearls / learning points

01Non-homogeneous (speckled, nodular, verrucous) leukoplakia carries a far higher malignant transformation risk than homogeneous.
02Floor of mouth and ventrolateral tongue are the highest-risk sites regardless of appearance.
03Excision does not remove the risk of transformation — surveillance continues.

§References

Warnakulasuriya S et al. Oral potentially malignant disorders. Oral Dis. 2021.
WHO Classification of Head and Neck Tumours, 5th ed. (2022).

§Related diseases

Leukoplakia

Predominantly white lesion of oral mucosa that cannot be characterised as any other definable lesion. A potentially malignant disorder.

Oral Lichen Planus

Chronic T-cell mediated mucocutaneous inflammatory disease with characteristic reticular white striae and, in erosive forms, painful ulcerations. Considered an oral potentially malignant disorder.

§Similar cases

OMFS-0107

Progressive trismus in an areca nut chewer

OMFS-0108

Bilateral reticular white striae with erosive areas

OMFS-0105

Non-healing ulcer of the lateral tongue in a smoker