Leukoedema

• A blue, grey or white appearance of the mucosa (especially the buccal mucosa)
• Considered by many to be a variant of normal

Epidemiology

• Incidence varies with ethnicities
  • Most common in black adults (90%)
• More common in smokers
• ♀ = ♂

Clinical Features

Leukoedema of buccal mucosa. Image from Huang et al. 2020

• Diffuse, blue-gray-white, milky opalescent appearance of the mucosa
• Asymptomatic
• Usually occurs bilaterally
• Commonest site is buccal mucosa
  • Can also occur on labial mucosa, palate or floor of mouth
• The mucosal surface can appear wrinkled and with white streaked lesions
• Can disappear or become less pronounced on stretching the mucosa
• Can also occur on the mucosa of the larynx or vagina

Differential Diagnosis

• Oral Lichen Planus
• Leukplakia
• Oral candidiasis
• White sponge nevus

Aetiology and Pathogenesis

• Unknown aetiology
• Because of how common the lesion is, it is considered by many to be variation of normal
• Some suggestion that it is an acquired condition caused by local irritation
  • Intracellular edema of the superficial epithelial cells coupled with retention of superficial parakeratin
• More common in smokers
  • Becomes less pronounced with smoking cessation
  • Smoking cannabis is known to be linked to this condition

Investigations

• Usually clinical examination alone is sufficient
• Biopsy may be needed to rule out differentials
• Exfoliative cytology (smear) may be helpful

Histopathology

• Increased epithelial thickness
• Elongated rete ridges
• Parakeratosis and intracellular edema of the spinous layer
• The cells of the spinous layer are vacuolated, large and possess pyknotic nuclei
• The superficial squamous cells have a clear, empty cytoplasm
  • Thought to be caused by water within the cells of the spinous layer causing the light to reflect back as whitish

Management

No treatment needed

Prognosis and Complications

Benign

Follow-up

No follow-up needed