Description: A red but not ulcerated area on mucous membrane is called erythroplasia. The texture may be normal or roughened. Size is variable, some being so small as to virtually escape detection whereas large areas are conspicuous to casual inspection. There are usually no symptoms. Being neither elevated nor depressed, they present as quiet, unpretentious lesions. The border may be sharp or blend imperceptibly into surrounding normal mucosa. It must constantly be kept in mind that early carcinoma frequently appears as an area of erythroplasia.
Etiology: Because there are several different diseases which appear as erythroplasia, there naturally are multiple etiologic agents. local irritants and infection are responsible for some lesions. For those which prove to be dysplastic or neoplastic, the etiology is unknown. Tobacco and alcohol are chief suspects.
Treatment: Treatment depends on the histologic findings. In those with an obvious cause, the cause should be eliminated. If the biopsy shows dysplasia, total excision is indicated. Those that show in-situ carcinoma or infiltrating carcinoma are treated appropriately.
Prognosis: This depends on the histologic diagnosis and extent of the lesion. In one study, more than 90% of oral erythroplakias were dysplastic (premalignant) or malignant on the day of the biopsy.
Differential diagnosis: lesions of physical trauma, chemical burns, infections and non-infectious mucositis, dysplasia, in-situ carcinoma and squamous cell carcinoma.
Comment: As mentioned in the section on carcinoma, there are certain areas of the oral mucosa which seem more prone to develop malignancy. Additionally, oral cancer is more often seen in those over age 40. Because of this, an area of erythroplasia in a cancer prone area in a patient past 40 is highly suspicious for malignancy and should be biopsied on the day it is seen. This is especially true for those lesions whose duration exceeds 2 weeks