What is leukoplakia, and is it cancer?

The NHS describes leukoplakia patches as usually painless, irregularly shaped, sometimes slightly raised, and impossible to rub or scrape away. They can have red areas. Common sites are on or under the tongue, the inner cheeks, gums and the floor or roof of the mouth. Because they do not hurt, they are often first noticed by a dentist.

"Leukoplakia" is a clinical label for a white patch that cannot be explained by anything else. Before using it, a dentist will rule out look-alikes such as thrush (which wipes off), cheek or tongue biting, friction from a sharp tooth, and lichen planus.

Location matters too: Cleveland Clinic notes patches on the tongue or floor of the mouth are more likely to become cancerous than those on the gums.

The exact cause is not always known, but the strongest link is tobacco in any form: cigarettes, pipes, cigars, chewing tobacco, snuff, paan and betel nut. Other factors include:

• Heavy, long-term alcohol use, which multiplies the risk when combined with tobacco
• Chronic irritation from rough teeth or ill-fitting dentures
• Conditions affecting the immune system, such as HIV

Cleveland Clinic describes leukoplakia as relatively rare, affecting less than 5% of people worldwide.

The NHS describes a small chance that leukoplakia could progress to mouth cancer over time. Cleveland Clinic estimates that less than 15% of people with leukoplakia develop oral cancer.

What raises concern:

• Red areas mixed in (speckled leukoplakia)
• A lumpy, warty or ulcerated surface
• Location on the side or underside of the tongue or floor of the mouth
• A patch that grows or changes
• Abnormal cells (dysplasia) on biopsy

Importantly, the risk does not fully disappear even after a patch is removed, which is why follow-up continues.

A biopsy is the only way to know whether a patch has abnormal cells. The NHS describes removing a small piece of the patch for testing, usually after referral to a specialist. Depending on the findings:

• Some patches are monitored with regular check-ups, especially if they are small and show no abnormal cells.
• Patches with a higher risk are removed, by scalpel, laser or other methods such as cryotherapy.
• Stopping tobacco, cutting down on alcohol and fixing sources of irritation may make a patch shrink or disappear.

Cleveland Clinic notes leukoplakia recurs in about 15% of cases after removal and recommends follow-up visits every 6-12 months for several years.

• Do not use any tobacco product, including chewing tobacco, paan and betel nut.
• Keep alcohol within recommended limits.
• Have dentures checked so they fit properly, and get sharp or broken teeth repaired.
• Eat a balanced diet with plenty of fruit and vegetables.
• Go to regular dental check-ups, which include an examination of the soft tissues of the mouth.

Cleaning or scraping the tongue has no role in treating leukoplakia. A white patch that does not lift with gentle cleaning is a reason to book a dental visit, not to scrape harder.