Erythroplakia -

Erythroplakia is a precancerous condition.
Useful in oral medicine and radiology
oral pathology

1. Oral Erythroplakia – A case report By ASWANTH.E.P

2. Introduction Erythroplasia describes precancerous red colour that develop on the penis .( Queyrat 1911) Oral erythroplakia defined as any lesion of oral mucosa that presents as bright red velvety plaques which cannot be characterized clinically or pathologically as any other recognizable condition(WHO)

3. Case report A 65 yrs old male patient complaints about loose teeth in upper right back region of the jaw since 2 month due to which he experienced difficulty in chewing food Past medical history- NRH Past dental history- NRH Habits – tobacco chewing 4-5 times a day since 35-38 yrs and bidi smoking 2-3 bidies per day since 50 yrs

4. Clinical examination Diffused erythematous patches was seen on the hard palate which extend into anterior part of the soft palate

5. Diffused vertical grooves on the palate Palate was soft and tender on palpation Bleeding on probing was seen from the grooves Depapillated areas are present on the dorsum of the tongue along with whitish coating which can be scrapable Saliva was found to be thick and ropy in consistency

6. Toluidine test procedure Step 1 : rinsing with water twice for 20 sec each after rinsing ,patient was asked to rinse with 1% acetic acid Step 2 : drying of area with gauze. Care was taken to not abrade the tissue while drying Step 3 : application of toluidine blue solution (1%) with cotton swab on the lesion . Swab was kept over the lesion for 15-20 sec Step 4 : rinsing with acetic acid followed by gargled with water Step 5 : positive staining of palate suggestive of dysplastic changes Dorsum of tongue give a false positive test as the stain was mechanically retained

7. Incisional biopsy Blood investigations Histological slide examination- to confirm erythoplasia

8. Surface of keratinize layer was seen to be thin Epithelial atrophy with mild dysplasia

9. Discussion Erythroplasia may appear as smooth velvety granular or nodular lesion with well defined margins Red lesions may sometimes associated with white spots or small plaques ( erythroleucoplakia ) Etiology Alcohol consumption Tobacco use

10. Classification by Shear A)Clinical variants -Homogeneous erythroplakia - Erythroplakia interspersed with patches of leukoplakia -Granular leukoplakia B)Inflammatory -Candida albicans infections -Tuberculosis - Histoplasmosis

11. Erythroplakia Early SCC Valvety red or granular red macule Red lesion on gingive Lesion has no apparent cause Lesion has apparent cause Gingival lesion does not respond to periodontaal therapeuticaal measures Gingival lesion respond to periodontaal therapeuticaal measures Age -50-70 yrs Mostly occurs in older men Differential diagnosis

12. Erythroplakia Erythematous candidiasis Valvety red or granular red macule Erythematous lesion Borders of lesion are sharp & well demarcated Borders are diffuse Site : Floor of mouth Site : Tongue,Palate Age : 50 – 70 years At any age Histologically thin epithelium ,dysplasia Candida albicans can be seen

13. Erythroplakia Erythema multiforme Age :50-70 yrs In young adults Valvety red or granular red macule Sloughing of oral mucosa with diffuse redness Red macule with white centre Site : Floor of mouth Buccaal mucosa,lips

14. Erythroplakia Leukoplakia Valvety red or granular red macule Whitish lesion Smooth margins Rough margins Age :50-70 yrs 35-40 yrs Site -Floor of tongue Buccal mucosa,tongue Thin epithelium Thick epithelium

15. Provisional diagnosis Oral erythroplasia Investigations Toluidine blue staining was carried out adjunct prior to incision biopsy With toluidine blue an acidophilic meta chromatic nuclear stain , will stain a dysplastic area due to its affinity for mitotic cells whereas normal mucosa will not retain the stain

16. Vital stainig with toluidine blue reveals the otherwise unapparent cytological details which was 1 st used by Richart in 1963 to stain uterine cervical carcinoma insitu Its application for detection of oral premalignant and malignant lesions was 1 st reported by Neibel and Chomet in 1964 It is basic meta chromatic dye that stains the acidic cellular components since cancer cells contains quantitatively more DNA and RNA than normal epithelial cells , toluidine blue has greater affinity for these cells

17. Malignant epithelium contains wider intra cellular canals which facilitate the greater penetration of the dye It is a simple fast and inexpensive technique Chance of false positive result due to mechanical retention in areas of inflammation ulceration and fissures can be reduced by restaining after 2 weeks Palate is stained positive suggestive of positive dysplastic changes Diagnosis of erythroplakia was confirmed by histological examination

18. conclusion Erythroplakia considered as one among the most severe of all oral premalignant lesions Incidence of severe dysplasia or carcinoma in this lesion is very high – 80-90% Histopathologically erythroplakia of homogenous type , 51% transform into invasive carcinoma, 40 % carcinoma insitu and 9% mild or moderate dysplasia It may associated with tobacco consumption and use of alcohol

19. In India betalnut pan and tobacco chewing is highy prevalent Oral Erythroplakia prevalence in India is about 0.2% Patient advised to stop tobacco or alcohol habits and encouraged to take diet rich in vegetables and fruits ( antioxidants ) Biopsy mandatory Treatment is surgical excision including laser Recurrence and development of malignancy at the sate site is very high

20. Reference 1)Oral Erythroplakia –a case report from International journal of applied dental sciences 2)Differential diagnosis of oral & maxillofacial lesions by by Norman K Wood & Paul W Goaz