Erythroplakia · What Is It, Causes, Treatment, and More

Erythroplakia is a pre-malignant condition that presents as a slow-growing, well-demarcated red patch on the membranes of the oral cavity.   

Lesions can be found on or under the tongue, on the floor of the mouth, or on the inner cheeks. The lesions of erythroplakia are often painless, but can also be tender or painful especially if there is co-infection with Candida fungus. Erythroplakia can be accompanied by leukoplakia, which refers to white or gray plaques of the oral mucosa.  

Those with leukoplakia and erythroplakia are at increased risk of developing carcinoma in situ or invasive carcinoma, which are forms of oral cancer.  

Erythroplakia is commonly diagnosed by a healthcare provider upon visual inspection of the oral cavity. A thorough medical history and review of signs and symptoms may also be completed to rule out similar oral conditions (e.g., oral candidiasis or trauma). 

Erythroplakia patches are often biopsied in which a sample of cells is taken from the lesion(s) and examined under a microscope. Biopsy is needed to confirm the presence of abnormal cells, including precancerous or cancerous cells. While mucosal biopsy (e.g., scalpel incision biopsy, punch biopsy) is the gold standard for definitive oral cancer diagnosis, exfoliative cytology, or brush biopsy, is a non-invasive diagnostic test in which mucosal lesions are gently scraped with a brush or wooden stick, and the cells are then examined microscopically.   

The severity of dysplasia can be graded in a five-step system: hyperplasia, mild, moderate, and severe dysplasia, followed by carcinoma in situ. Squamous cell carcinoma can develop if the lesion is left untreated.  

Additional diagnostic approaches include fluorescence staining, where a special mouth rinse is used along with a fluorescent light to help visualize abnormal areas. Toluidine blue stain is another diagnostic method in which a blue dye is used to coat erythroplakia lesion(s) in the mouth; areas that turn darker may indicate the presence of precancerous or cancerous cells. These tools typically help guide where the biopsy is taken.  

Early detection and diagnosis of erythroplakia is necessary since erythroplakia may develop without pain or other symptoms and, therefore, may go unnoticed; this increases the risk of developing oral cancer. 

Erythroplakia may be treated through a variety of approaches, including behavioral changes. Individuals may be asked to avoid risk factors such as smoking or chewing tobacco or drinking alcohol. It can be important to optimize oral health with good oral hygiene practices and attend regular dental visits. Once the diagnosis is made, treatment decisions are commonly based on size and location of the lesion(s), biopsy findings, individual risk factors, and medical history. For example, laser surgery is a surgical procedure that uses a laser beam to remove erythroplakia from the oral cavity. Cryosurgery involves the local application of an intense cooling agent, such as liquid nitrogen, to destroy erythroplakia tissue and any abnormal cells. Additionally, traditional surgery involves the use of a scalpel to remove erythroplakia tissue. If the erythroplakia becomes cancerous, radiation therapy may be considered in which high doses of radiation are used to kill cancerous cells. 

After treatment of erythroplakia, individuals may require life-long monitoring through regular dental visits approximately every 3 to 12 months as recurrent lesions can occur.