The initial definition of leukoplakia by the World Health Organization (WHO) as a 'white mucosal lesion' was refined to indicate "a white patch or plaque that cannot be characterized clinically or pathologically as any other disease" - with the inherent acknowledgement that the lesion may represent a cancer or a precursor to development of a cancer.
Further refinement in the definition has led to the contemporary definition of leukoplakia as "white plaques of questionable risk having excluded (other) known disease or disorder that carry no increased risk for cancer"
Benign Leukoplakia |
Pre-malignant Leukoplakia |
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Severe squamous dysplasia or Carcinoma in situ causing laryngeal leukoplakia |
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Infectious proliferations causing leukoplakia |
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Invasive squamous cell carcinoma causing laryngeal leukoplakia |
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Imaging |
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Narrow band imaging of vocal cord leukoplakia flexible transnasal videolaryngoscopy |
Surgical Approach |
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Esophagoscopy with narrow band imaging (NBI) for Reflux Esophagitis |
Endoscopic Resection of Vocal Cord (Fold) Leukoplakia "Floating the Lesion" (video) |
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Some reports use terms keratosis and leukoplakia interchangeably
Detection
- Often asymptomatic - incidental (larynx inspected by anesthesia / GI / Rhinology)
- Associations: Dysphonia (throat irritation / chronic cough rarely result from the leukoplakia)
Incidence/Prevalence
- Autopsy study (37 years ago) – 19% of males with ‘laryngeal keratosis’ - 80% were smokers.
- Laryngeal keratosis seen in only 4.2% of nonsmokers (Muller 1980)
- Medical record review 1935-84 Rochester Minnesota (Bouquot 1991)
- Annual incidence of detection:
- vocal fold keratosis in 10.2/100,000 males and 2.1/100,000 females
- asymptomatic laryngeal keratosis (leukoplakia) was not included in study
- Annual incidence of detection:
Table below derived from Isenberg, Crozier and Dailey (2008) "Institutional and comprehensive review of laryngeal leukoplakia" Ann otol Rhinol Laryngol 2008;117:74-9:
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Leukoplakia |
N |
No Dysplasia |
Mild/Mod Dysplasia |
Severe Dysplasia/CIS |
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U of Wisconsin |
208 biopsies 136 patietns |
53% |
18% |
15% |
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15 publications |
2,188 biopsies |
53.6% |
33.5% |
15.2% |
Noted discordance with confusion among pathologists regarding degree of dysplasia (Gupta 2010) and (El-Naggar AK 2017)
References
Gale et al “Epithelial precursor lesions” in Barnes et al (eds) Pathology and Genetics: head and neck tumours IARC Press 2005
Warnakulasuria et al: Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med. 2007;36:575-80
Bouquot JE, Gnepp DR (1991) Laryngeal precursor: a review of the literature, commentary, and comparison with oral leukoplakia. Head Neck. 13:488-97
Bouquot et al Cancer Detect Prev. 1991;15:83-91
Muller and Krohn J Cancer Res Clin oncol. 1980;96:211-7
Isenberg, Crozier and Dailey (2008) "Institutional and comprehensive review of laryngeal leukoplakia" Ann otol Rhinol Laryngol 2008;117:74-9
Gupta HT, Robinson RA, Murray RC, Karnell LH, Smith RJH and Hoffman HT: Degrees of Dysplasia and the Use of Cidofovir in Patients with Recurrent Respiratory Papillomatosis Laryngoscope 120:698-702, 2010
El-Naggar AK, Chan JKC, Grandis JR, Takata Takashi, and Slootweg PJ: WHO Classification of Head and Neck Tumorurs. 4th Edition International Agency for Research on Cancer lyon, 2017
Cosway B and Paleri V: Laryngeal dysplasia: An evidence-based flowchart to guide management and follow up The Journal of Laryngology & Otology (2015), 129, 598-599