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Erythroplakia

What Is It, Causes, Treatment, and More

Author:Ali Syed, PharmD

Editors:Alyssa Haag,Emily Miao, PharmD,Kelsey LaFayette, DNP, RN

Illustrator:Abbey Richard

Copyeditor:David G. Walker


What is erythroplakia?

Erythroplakia is an atypical, painless, slow-growing red patch or lesion on the mucous membranes of the oral cavity. These lesions may be flat or raised, have well-defined margins, and are most commonly found on the tongue or floor of the mouth alongside leukoplakia lesions, which are white or gray patches that develop on the tongue or buccal mucosa. Erythroplakia is characterized by decreased epithelial cells and increased vascularization, which gives it its red color and increased friability. As such, leukoplakia and erythroplakia differ in color, and if scraped, erythroplakia lesions tend to bleed easily, whereas leukoplakia lesions cannot be removed and do not bleed easily.

Illustration of lateral aspect of a tongue with red patch on it.

Is erythroplakia a type of cancer?

Erythroplakia and leukoplakia are generally considered to be potential precancerous conditions of the mouth. Precancerous lesions are known as dysplasia, and may be categorized as mild, moderate, or severe with severe dysplasia being more likely to become cancerous. If left untreated, erythroplakia and leukoplakia may progress to  oral cancer by undergoing malignant transformation and becoming cancerous cells. It is important to note, however, that not all patches in the mouth are precancerous or cancerous.

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What causes erythroplakia?

Erythroplakia is most commonly caused by heavy smoking, chewing tobacco, and excessive alcohol use. Additional risk factors for developing erythroplakia include poor oral health, long-term trauma to the oral cavity (e.g., poor fitting dentures), advanced age, and infection with human papillomavirus (HPV). Erythroplakia may also present without a clear cause (i.e., idiopathic).

How is erythroplakia diagnosed?

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). 

Diagnosis of erythroplakia may be confirmed with a biopsy in which a sample of cells is taken from the lesion(s) and examined in a lab. Biopsy results may also confirm the presence of abnormal cells, including precancerous or cancerous cells. Exfoliative cytology is a diagnostic biopsy method in which erythroplakia lesion(s) in the mouth and throat are gently scraped with a brush or wooden stick to collect cells and examine them under a microscope.

Additional diagnostic approaches include fluorescence staining in which an individual uses a special mouth rinse and a fluorescent light is used to 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, and areas that turn darker may indicate the presence of precancerous or cancerous cells. 

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.

How is erythroplakia treated?

Erythroplakia may be treated through a variety of approaches, including cessation of modifiable risk factors with close clinician follow-up, radiation, laser surgery, cryosurgery, or surgery. Treatment decisions are commonly based on size and location of the lesion(s), biopsy findings, individual risk factors, and medical history.

Since erythroplakia can develop into oral cancer, individuals with this condition are advised to avoid known risk factors, such as tobacco and alcohol consumption; optimize oral health by practicing good oral hygiene; attend regular dental visits; and closely monitor their lesions to observe if any resolve on their own. 

If erythroplakia does not resolve on its own, other treatment options may be considered. 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.

Upon successful treatment of erythroplakia, future prevention strategies involve avoidance of risk factors, practicing good oral hygiene, and life-long monitoring through regular dental visits approximately every 3 to 12 months as many individuals may experience recurrent lesions.

What are the most important facts to know about erythroplakia?

Erythroplakia is an atypical lesion on the mucous membranes of the oral cavity and tends to bleed easily when scraped. Erythroplakia is considered to be a precancerous condition of the mouth. If left untreated, erythroplakia may progress to oral cancer. Erythroplakia is most commonly caused by heavy smoking, chewing tobacco, and excessive alcohol use but may also present without a clear underlying cause. It is commonly diagnosed by a clinician upon visual inspection of the oral cavity. Diagnosis of erythroplakia may be confirmed with a biopsy in which results may confirm the presence of abnormal cells, including precancerous or cancerous cells. Treatment may occur through a variety of approaches, including avoidance of modifiable risk factors with close clinician follow-up, radiation, laser surgery, cryosurgery, or surgery. Future prevention of erythroplakia may involve avoidance of risk factors, practicing good oral hygiene, and close monitoring through regular dental visits.

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Related links

Anatomy of the oral cavity
Oral cancer

Resources for research and reference

Bouquot, J. E., & Ephros, H. (1995). Erythroplakia: the dangerous red mucosa. Practical Periodontics and Aesthetic Dentistry, 7(6): 59-67. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9002888/

Erythroplakia (2022). In Jefferson Health. Retrieved April 1, 2022, from https://hospitals.jefferson.edu/diseases-and-conditions/erythroplakia.html

Is erythroplakia a red flag to oral cancer?. (2022). In Colgate. Retrieved April 1, 2022, from https://www.colgate.com/en-us/oral-health/cancer/erythroplakia-oral-cancer

Leukoplakia and Erythroplakia. (2022). In Cancer Treatment Centers of America. Retrieved April 1, 2022, from https://www.cancercenter.com/cancer-types/oral-cancer/risk-factors/leukoplakia-erythroplakia

Precancerous conditions of the mouth. (2022). In Canadian Cancer Society. Retrieved April 1, 2022, from https://cancer.ca/en/cancer-information/cancer-types/oral/what-is-oral-cancer/precancerous-conditions

Reichart, P. A., & Philipsen, H.P. (2005). Oral erythroplakia - a review. Oral Oncology 41(6): 551-61. DOI: 10.1016/j.oraloncology.2004.12.003