High rate of Cancer

# Increased incidence of carcinoma is observed with:
a) Homogenous leukoplakia
b) Verrucous leukoplakia
c) Nodular leukoplakia
d) None of the above

The correct answer is C. Nodular Leukoplakia.

Clinically, Leukoplakia is of three types:
A. Homogenous
B. Speckled or Nodular
C. Proliferative verrucous leukoplakia (PVL)

A. Homogenous
• Appears as translucent white, raised area. • It is non-palpable i.e., same as surrounding mucous membrane.
• Differential diagnosis is hyperplastic lichen planus.

B. Speckled or Nodular 
• Raised from surface with red and white areas.
• Mostly seen at the angle of mouth and commissures of lips in chronic smokers.
• Indurations, fissuring and ulcer formation is seen
• The epithelial dysplasia is more common and has more tendency for malignancy.

C. Proliferative verrucous leukoplakia (PVL) 
• First described by Hansen and is associated with a high risk of progression to squamous cell carcinoma.
• May be associated with human papilloma virus (HPV)
• Seen as white papilliferous or cauliflower like growth
• Commonly seen in the region, where the quid is kept for long time
• No fixity is seen
• Differential diagnosis is verrucous carcinoma.

The forms of leukoplakia according to CURRENT classifications are:
1) Homogeneous: 
Lesions that are uniformly white.
a) Smooth
b) Furrowed (Fissured)
c) Ulcerated

2) Nonhomogeneous nodulospeckled: Lesion with well demarcated raised white areas, interspersed with reddened areas. It is applicable to both color (mixed red and white lesion -erythroleukoplakia) and texture (exophytic, papillary or verrucous).

Proliferative verrucous leukoplakia is a term used to describe a clinically aggressive form or oral leukoplakia with a strong potential for malignant transformation.


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