Erythroplakia / Erythroplasia

Erythroplakia (Greek, “flat red area”) is defined as a fiery red patch that cannot be characterised either clinically or pathologically as any other definable lesion.

These may appear as a bright red, smooth, velvety, granular or nodular lesions often with a well-defined margins adjacent to normal looking mucosa and are usually asymptomatic.

The soft palate, the floor of mouth, the ventral surface of tongue and the retro-molar area are the most common sites of involvement.

Erythroplakia is more common among middle aged to elderly persons and, especially among men. It is less common than leukoplakia.

The prevalence of these lesions range from 0.02 – 0.83% in different regions.

Ætiology

The risk factors for erythroplakia are the same as for oral squamous cell carcinoma.

Diagnosis

Erythroplakia is seldom multi-centric and rarely covers extensive areas of the mouth. It is soft on palpation and does not become indurated until an invasive carcinoma develops in it.

It is often asymptomatic, although some patients may complain of a sore, burning or metallic sensation.

Oral erythroplakia has the highest risk of malignant transformation compared to all other mucosal lesions ie Most potentially malignant of all oral mucosal lesions.

All erythroplakias should be viewed with extreme clinical suspicion for malignancy, as they are more likely to harbour histological foci of severe dysplasia, carcinoma in-situ (CIS) or micro-invasive cancer.

The incidence of severe dysplasia or carcinoma in these lesions is very high (80 – 90%) and biopsy is mandatory. Areas of erythroplakia may also co-exist with leukoplakia in so-called “mixed” or “speckled” lesions (erythro-leukoplakia).

Care must be taken to obtain a representative biopsy specimen in such cases, with sampling of multiple areas within the lesion, as carcinoma may be present only focally.

It appears as a usually asymptomatic, fiery red, well demarcated plaque, with a smooth and velvety surface, usually level / depressed with surrounding mucosa. The red lesions may be associated with white spots or small plaques.

The floor of the mouth, retro-molar area, soft palate, and tongue are the most common sites of involvement.

Erythroplakias occurs more frequently between the ages of 50 and 70 years.

Laboratory Tests

Histo-pathological examination.

Differential Diagnosis

The following conditions should be considered before making a diagnosis of erythroplakia:

Local irritation
Early squamous cell carcinoma
Invasive oral cancer
Discoid lupus erythematous
Lupus erythematosus
Non-homogeneous leukoplakia
Erosive lichen planus
Acute atrophic candidiasis
Erythematous candidiasis
Denture induced stomatitis
Pemphigus
Hæmangioma

Management / Treatment

Management of oral erythroplakia focuses on the prevention of malignant transformation and early detection of occult malignancy.

Persons with erythroplakia should be advised to stop tobacco / alcohol habits and should be encouraged to take a diet rich in vegetables and fruits (anti-oxidants).

In view of the high malignant potential of these lesions, the recommended treatment is surgical excision, including laser. However, even after surgical excision, the recurrences and development of malignancy at the same site are high. In view of this, long-term follow-up is essential even after surgical removal.