Oncology (General Cancer)/Leukoplakia

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Question
Results from oral biopsey: Leukoplakia.   Representative sections show variably thickened squamous epithelium with blunted papilary type hyperplasia, hyperkeratosis and focal parakeratosis. Mild underlying chronic inflammation is identified including a focal lichenoid type pattern. Variable hypergranulosis is also present suggestive of chronic irritation. No definite koilocytic type change is identified. The nuclei at the base of teh squamous surface epithelium are enlarged and mildly atypical with scattered mitotic figures with occasional dyskeratotic cells. special staiins for fungus (PAS-D) are negative. These findings are consistent with mild dysplasia that extends to a single side (Lateral) margin. No invasive componet is identified.  
What approach should I be taking, the oral surgion has a wait and see approach but since there are other cells remaining I fear oral cancer will develop.

Answer
Although leukoplakia is a risk factor for oral cancer, their is evidence that even if the leukoplakia is removed, the risk remains.  Probably the same things that cause leukoplakia cause oral cancer).  Leukoplakia will go away if the cause is removed. Causes include smoking and exposure of the mucus membranes to alcohol.  Also dental irritation and poor dental hygene are associated.  Many people with leukoplakia however, don't have obvious risk factors. Most doctors would not remove leukoplakia patches since there's no evidence that helps anything.  There is evidence that risks of cancer can be reduced by stopping the use of alcohol and/or tobacco, and by high anti-oxidant diets.  Hope this helps.  Also, you should be very familiar with the inside of your mouth, and examine it about once a month with a mirror and a light, as well as your finger.  Areas which are raised or "friable" (bleed easily when touched) are suspicious.  Increase or decrease in the area covered by the leukoplakia is not a reason for panic, though.  Oral cancers, if caught early, are usually curable.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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