Erythroplakia

Erythroplakia is a clinical term to describe any erythematous (red) area on a mucous membrane,[2] that cannot be attributed to any other pathology.[3]: 805 

Erythroplakia
Other namesErythroplasia[1]: 734 
Erythroleukoplakia ("speckled leukoplakia"), left commissure. Biopsy showed mild epithelial dysplasia and candida infection. Antifungal medication may turn this type of lesion into a homogenous leukoplakia (i.e. the red areas would disappear)
SpecialtyOral medicine 

The term erythroplasia was coined by Louis Queyrat to describe a precancerous red lesion of the penis.[4] This gave rise to the term erythoplasia of Queyrat. Depending upon the context, this term may refer specifically to carcinoma in situ of the glans penis or vulva appearing as a red patch, or may be used as a synonym of erythroplasia on other mucous membrane or transitional sites.[5]

It mainly affects the glans penis (the head of the penis),[6] although uncommonly it may present on the mucous membranes of the larynx,[2] and rarely, the mouth,[6][7] or the anus.[8]

Erythroplakia is analogous to the term leukoplakia which describes white patches. Together, these are the 2 traditionally accepted types of premalignant lesion in the mouth,[9][10] When a lesion contains both red and white areas, the term "speckled leukoplakia" or "eyrthroleukoplakia" is used.

Although oral erythroplakia is much less common than leukoplakia,[7] erythroplakia carries a significantly higher risk of containing dysplasia or carcinoma in situ, and of eventually transforming into invasive squamous cell carcinoma (a type of oral cancer).[2][7]

Signs and symptoms

Although often the terms erythroplasia and erythroplakia are used synonymously, some sources distinguish them, stating that the latter is macular (flat) while the former is papular (bumpy).[11]

Erythroplakia of the genital mucosae is often referred to as erythroplasia of Queyrat.

The most common areas in the mouth where erythroplakia is found are the floor of the mouth, buccal vestibule, the tongue, and the soft palate. It appears as a red macule or plaque with well-demarcated borders. The texture is characterized as soft and velvety. An adjacent area of leukoplakia may be found along with the erythroplakia.

Erythroplasia may also occur on the laryngeal mucosa,[2] or the anal mucosa.[8]

Causes

Erythroplakia has an unknown cause but researchers presume it to be similar to the causes of squamous cell carcinoma. Carcinoma is found in almost 40% of erythroplakia.[12] It is mostly found in elderly men around the ages of 65 - 74. It is commonly associated with smoking.

Alcohol and tobacco use have been described as risk factors.[13]

Diagnosis

Differential diagnosis of an oral red lesion

There are many other conditions that are similar in appearance and must be ruled out before a diagnosis of erythroplakia is made (see table). Sometimes, a diagnosis is delayed for up to two weeks in order to see if the lesion spontaneously regresses on its own or if another cause can be found. Erythroplakia frequently is associated with dysplasia, and is thus a precancerous lesion.

Biopsy

Microscopically, the tissue exhibits severe epithelial dysplasia, carcinoma-in-situ, or invasive squamous cell carcinoma in 90% of cases. There is an absence of keratin production and a reduced number of epithelial cells. Since the underlying vascular structures are less hidden by tissue, erythroplakia appears red when viewed in a clinical setting.

Treatment

Treatment involves biopsy of the lesion to identify extent of dysplasia. Complete excision of the lesion is sometimes advised depending on the histopathology found in the biopsy. Even in these cases, recurrence of the erythroplakia is common and, thus, long-term monitoring is needed.

History

In 1911, French dermatologist Louis Queyrat described a sharply defined, bright red, glistening velvety precancerous lesion of the glans penis.[14] He coined the term "erythroplasie" to designate red plaques as an analogy to "leucoplasie", which designated white patches.[14] Since "leucoplasie" was the equivalent of the English leukoplakia (coined in 1861),[15] the term became erythroplakia in English.[14] Similarly, the term leukoplakia was originally coined to describe white lesions of the urinary tract,[15] and in 1877 was first applied to white patches in the mouth.[16] It is unclear when the term erythroplakia was first adapted to describe red lesions in the mouth.[14]

Etymology

The word erythroplakia means "red patch", and is derived from the Greek words ερυθρος - "red" and πλάξ - "plate" The World Health Organization defines oral erythroplakia as follows:

Any lesion of the oral mucosa that presents as bright red velvety plaques which cannot be characterized clinically or pathologically as any other recognizable condition

References
  1. Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
  2. Barnes L, ed. (2008). Surgical pathology of the head and neck Vol. 1 (3rd ed.). New York: Informa Healthcare. pp. 131, 275–277. ISBN 9780849390234.
  3. James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 978-0-7216-2921-6.
  4. Lee C, Damm DD, Neville BW, Allen C, Bouquot J (2009). Oral and maxillofacial pathology (3rd ed.). St. Louis, Mo.: Saunders/Elsevier. pp. 397, 398. ISBN 9781437721973.
  5. Braun-Falco O (2000). Dermatology (2nd ed.). Berlin [u.a.]: Springer. p. 1457. ISBN 9783540594529.
  6. Laskaris G (2011). Treatment of oral diseases a concise textbook. Stuttgart: Thieme. p. 68. ISBN 9783131613714.
  7. Scully C (2013). Oral and maxillofacial medicine: the basis of diagnosis and treatment (3rd ed.). Edinburgh: Churchill Livingstone. pp. 184–185. ISBN 978-0-7020-4948-4.
  8. Katsambas AD, Lotti TM, eds. (2003). European handbook of dermatological treatments (2nd ed.). Berlin [u.a.]: Springer. p. 169. ISBN 9783540008781.
  9. Fischman SL, Ulmansky M, Sela J, Bab I, Gazit D (August 1982). "Correlative clinico-pathological evaluation of oral premalignancy". Journal of Oral Pathology. 11 (4): 283–9. doi:10.1111/j.1600-0714.1982.tb00168.x. PMID 6809916.
  10. Boy SC (November 2012). "Leukoplakia and erythroplakia of the oral mucosa-- a brief overview". South African Dental Journal. 67 (10): 558–60. PMID 23957095.
  11. "erythroplasia" at Dorland's Medical Dictionary
  12. Ridge JA, Glisson BS, Lango MN, et al. "Head and Neck Tumors" Archived July 20, 2009, at the Wayback Machine in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach Archived October 4, 2013, at the Wayback Machine. 11 ed. 2008.
  13. Hashibe M, Mathew B, Kuruvilla B, et al. (July 2000). "Chewing tobacco, alcohol, and the risk of erythroplakia". Cancer Epidemiol. Biomarkers Prev. 9 (7): 639–45. PMID 10919731.
  14. Srivastava G (2008). Essentials of oral medicine. New Delhi: Jaypee Brothers Medical publishers. pp. 72–73. ISBN 9788184482126.
  15. Petrou S.P.; David M. Pinkstaff; Kevin J. Wu; Kenneth J. Bregg (November 2003). "Leukoplakia of the Bladder". Cliggott Publishing. Retrieved May 6, 2013.
  16. Tanaka T, Tanaka M, Tanaka T (January 1, 2011). "Oral Carcinogenesis and Oral Cancer Chemoprevention: A Review". Pathology Research International. 2011: 431246. doi:10.4061/2011/431246. PMC 3108384. PMID 21660266.
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