erythroplakia

Erythroplakia is a red patch of the oral mucosa that cannot be attributed to local irritation or trauma and is recognized clinically as a lesion with high malignant potential. On biopsy, most erythroplakias show epithelial dysplasia, carcinoma in situ, or invasive squamous cell carcinoma, making it one of the most important precancerous lesions of the oral cavity.

Epidemiology and risk factors: Erythroplakia is relatively uncommon. It occurs predominantly in older adults and more often in men. Tobacco use and heavy alcohol consumption are major risk factors, and other influences include betel quid chewing in certain populations.

Clinical features: The lesion presents as a well-demarcated, red, velvety patch or plaque, sometimes flat and smooth, sometimes slightly raised. It is usually non-scrapable and most frequently affects the floor of the mouth, the lateral tongue border, the soft palate, or the retromolar area.

Diagnosis: Definitive diagnosis requires histopathologic examination obtained by biopsy. Because erythroplakia carries a high likelihood of dysplasia or carcinoma, prompt biopsy is indicated for any persistent red patch. Histology ranges from mild dysplasia to severe dysplasia, carcinoma in situ, or invasive carcinoma.

Differential diagnosis includes leukoplakia with erythroplakia, candidiasis, wound healing, lichen planus, and other inflammatory lesions.

Management and prognosis: Treatment is guided by histology. Lesions with dysplasia or higher grade are typically treated with surgical excision or wider local resection; invasive cancers require oncologic management. Smoking cessation and alcohol reduction are advised, and patients require regular long-term follow-up due to risk of recurrence or new lesions. Overall, erythroplakia carries a higher malignant transformation risk than leukoplakia, and early detection improves prognosis.