Erythroplakia (Greek, “flat red area”) is defined as a fiery
red patch that cannot be characterised either clinically or
pathologically as any other definable lesion.
These may appear as a bright red, smooth, velvety,
granular or nodular lesions often with a well-defined
margins adjacent to normal looking mucosa and are usually
The soft palate, the floor of mouth, the ventral surface of
tongue and the retro-molar area are the most common
sites of involvement.
Erythroplakia is more common among middle aged to
elderly persons and, especially among men. It is less
common than leukoplakia.
The prevalence of these lesions range from 0.02 - 0.83%
in different regions.
The risk factors for erythroplakia are the same as for oral
squamous cell carcinoma.
Erythroplakia is seldom multi-centric and rarely covers
extensive areas of the mouth. It is soft on palpation and
does not become indurated until an invasive carcinoma
develops in it.
It is often asymptomatic, although some patients may
complain of a sore, burning or metallic sensation.
Oral erythroplakia has the highest risk of malignant
transformation compared to all other mucosal lesions ie
Most potentially malignant of all oral mucosal lesions.
All erythroplakias should be viewed with extreme clinical
suspicion for malignancy, as they are more likely to
harbour histological foci of severe dysplasia, carcinoma in-
situ (CIS) or micro-invasive cancer.
The incidence of severe dysplasia or carcinoma in these
lesions is very high (80 – 90%) and biopsy is mandatory.
Areas of erythroplakia may also co-exist with
in so-called “mixed” or “speckled” lesions (erythro-
Care must be taken to obtain a representative biopsy
specimen in such cases, with sampling of multiple areas
within the lesion, as carcinoma may be present only focally.
The following conditions should be considered before making a diagnosis of
Management / Treatment
Management of oral erythroplakia focuses on the prevention of malignant
transformation and early detection of occult malignancy.
Persons with erythroplakia should be advised to stop tobacco / alcohol habits and
should be encouraged to take a diet rich in vegetables and fruits (anti-oxidants).
In view of the high malignant potential of these lesions, the recommended
treatment is surgical excision, including laser. However, even after surgical
excision, the recurrences and development of malignancy at the same site are
high. In view of this, long-term follow-up is essential even after surgical removal.
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