Background
The World Health Organization (WHO) first defined oral leukoplakia as a white patch or plaque that could not be characterized clinically or pathologically as any other disease; therefore, conditions including, but not limited to, lichen planus, candidiasis, and white sponge nevus were excluded. At a 1983 international seminar, the following definition was proposed:
Leukoplakia is a whitish patch or plaque that cannot be characterized clinically or pathologically as any other disease, and is not associated with any physical or chemical causative agent, except the use of tobacco.
A more recent WHO workshop
has amended the earlier WHO definition as follows: “The term leukoplakia should be used to recognize white plaques of questionable risk having excluded (other) known diseases or disorders that carry no risk for cancer.” It has also recommended abandoning the distinction between the terms “potentially malignant lesions” and “potentially malignant conditions” and to use the term “potentially malignant disorders” instead. Leukoplakia and erythroplakia are the most common potentially malignant disorders. These diagnoses are still defined by exclusion of other known white or red lesions. Not included in the discussion concerning leukoplakias are the rare inherited or genetically driven forms of oral white lesions, which include white sponge nevus, among others.
Oral white lesions include leukoplakias (as defined above), keratoses, leukoplakias of clear infective origin (candidal, syphilitic, hairy leukoplakia associated with Epstein-Barr virus), candidosis, lichen planus, oral submucous fibrosis, lupus erythematosus, congenital lesions (eg, white sponge nevus, dyskeratosis congenita, pachyonychia congenita), and frank carcinomas.