Show Contents
Abdullakutty, Dua, Kichenaradjou, and Coombes:

Leukoedema of the buccal mucosa - A case report

Vaidhehi Narayan Nayak1, H. C. Girish1, Sanjay Murgod1, R. Narahari2, B. N. Yathindra Kumar1

[1] Department of Oral Pathology, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India[2] Department of Oral Surgery, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India

Correspondence: Dr. Vaidhehi Narayan Nayak, Department of Oral Pathology, Rajarajeswari Dental College and Hospital, Kumbalgodu, Ramohally Cross, Bangalore – 560074, Karnataka, India. E-mail: vaidhehinayak@gmail.com

Received: 16 June 2018;
Accepted: 20 July 2018
doi: 10.15713/ins.jmrps.138

Abstract

Leukoedema is a variant of oral mucosa which mimics premalignant lesion more so when there is associated smoking habit. We report a case of leukoedema which had a strong smoking habit.

Keywords Leukoedema, premalignancy, smoking


Introduction

Leukoedema is the normal anatomic variant of the oral mucosa which has clinical appearance similar to potentially malignant white lesions such as leukoplakia and lichen planus. Other lesions which closely mimic leukoedema are white sponge nevus and cheek bite. Its association with smoking habit is unclear. The present case of leukoedema discussed here has strong smoking habit association.

Case Report

A 28-year-old male patient complains of grayish-white patch on the left and right buccal mucosae. The patient gave a history of smoking six cigarettes per day for 6 years. The patch was noticed accidentally while brushing teeth. The general physical examination was non-contributory and the lesion was asymptomatic. On examination, the lesion is grayish-white in color with irregular borders which present at the level of occlusal plane in both the right and left buccal mucosae extending to retromolar trigone area [Figure 1]. Lesion was non-scrapable and persisted after stretching the mucosa. Based on the clinical examination and prevalent smoking habit, provisional diagnosis of leukoplakia was given. Biopsy of the lesion was performed to confirm the diagnosis.

thumblarge

Figure 1 Leukoedema of the buccal mucosa seen as whitish gray line at the level of occlusal plane

Histopathology

Histopathological examination reveals hyperparakeratosis and acanthosis of surface epithelium. Cells of the spinous layer show intracellular edema. Cells appear pale and have pyknotic nucleus [Figure 2]. No dysplastic features were observed. Based on clinicopathologic correlation, final diagnosis of leukoedema was given.

thumblarge

Figure 2 H and E stained section under ×10 magnification shows edematous spinous layer

Treatment

No treatment is required for leukoedema, although topical application of tretinoin has shown a promising result in symptomatic cases.[1]

Discussion

Leukoedema is considered as an abnormality of oral mucosa in which leukoplakia is most likely to occur.[2] It occurs bilaterally but unilateral cases have also been reported.[3] The present case was bilateral grayish-white lesion on the buccal mucosa at the level of occlusal plane. On stretching the mucosa, the lesion persisted. It did not disappear or become more prominent which rules out white sponge nevus and lichen planus, respectively.

The association of smoking and leukoedema has been controversial. In the present case, the patient had smoking habit of 6 years. In an Indian study consisting of 50,915 populations, the incidence of leukoedema was only 0.11%, and among the cases, smoking habit was prevalent.[4] In a study by van Wyk, an association of leukoedema and smoking was investigated, and no positive association was established.[5] They concluded that smoking does not cause leukoedema but may aggravate it. Leukoedema was once considered as premalignant lesion but has been discredited as it is proved to have no malignant potential.[6]

The incidence of leukoedema varies worldwide. A definite racial predilection to African origin individuals has been observed in few studies.[7,8] High incidence of leukoedema was noted in a study by Roy et al., 1972, in which 400 patients of 430 examined had leukoedema, whereas the study by Axéll and Henricsson showed 48.9% incidence of leukoedema.[9,10]

Indian experience with leukoedema has been low as observed from reported cases. Anuna et al. reported a prevalence of 3.78% in their study from Southern India.[11] Joshi and Tailor had 0.81% prevalence of leukoedema in their study from central Gujarat.[12] A largest study group from four states of India comprising of 50,915 villagers had a prevalence of 0.11%.[13]

Conclusion

Leukoedema is a harmless white lesion of the oral cavity which mimics premalignant lesion more so when it is associated with smoking. A prompt biopsy will help arrive at the diagnosis. More studies are needed to assess the actual prevalence of leukoedema in India and worldwide.

References

1. Duncan SC, Su WP, Leukoedema of the oral mucosa. Possibly an acquired white sponge nevusArch Dermatol 1980; 116: 906-8.

2. Rajendran R, Sivapathasundharam B, Benign and malignant tumors of the oral cavityShafer's Textbook of Oral Pathology 2009; 6th ed. New Delhi: Elsevier India Pvt Ltd; 92-

3. Negm SA, Unilateral leucoedema-case reportInt J Dent Clin 2013; 5: 21-2.

4. Hammer JE, Mehta FS, Pindborg J, Daftary DK, An epidemiologic and histopathologic study of leukoedema among 50, 915 rural Indian villagersOral Surg Oral Med Oral Pathol 1971; 32: 58-65.

5. van Wyk CW, An investigation into the association between leukoedema and smokingJ Oral Pathol 1985; 14: 491-9.

6. Sunitha C, Gabiel SR, Rajgopal S, Donald F, A brief review of common oral premalignant lesions with emphasis on their management and cancer preventionIndian J Surg 2011; 73: 256-61.

7. Martin JL, Leukoedema:A review of the literatureJ Natl Med Assoc 1992; 84: 938-40.

8. Archard HO, Carlson KP, Stanley HR, Leukoedema of the human oral mucosaOral Surg Oral Med Oral Pathol 1968; 25: 717-28.

9. Roy TD, Roger T, Giuseppe ED, Leukoedema of the oral mucosaJ Am Dent Assoc 1972; 85: 1105-9.

10. Axéll T, Henricsson V, Leukoedema-an epidemiologic study with special reference to the influence of tobacco habitsCommunity Dent Oral Epidemiol 1981; 9: 142-6.

11. Anuna LM, Keerthilatha MP, Amar AS, Manoj V, The prevalence of oral mucosal lesions in patients visiting a dental school in Southern IndiaIndian J Dent Res 2008; 19: 99-103.

12. Joshi M, Tailor M, Prevalence of most commonly reported tobacco-associated lesions in central Gujarat:A hospital-based cross-sectional studyIndian J Dent Res 2016; 27: 405-9.

13. Sandstead HR, Lowe JW, Leukoedema and keratosis in relation to leukoplakia of the buccal mucosa in manJ Natl Cancer Inst 1953; 14: 423-37.