Most idiopathic leukoplakias are homogenous leukoplakias and show little evidence of dysplastic histological changes or aneuploidy. Erythroleukoplakias, verrucous leukoplakias, and nodular leukoplakias show an increasing frequency of such changes. Increased prevalence is observed in communities and races with high tobacco use, such as Southeast Asia. Leukoplakias usually are asymptomatic and are noticed initially by the dentist at a routine examination. Most leukoplakias are seen on the lip, buccal mucosae, or gingivae.
Size appears irrelevant.
Even small dysplastic lesions may lead to multiple carcinomas and a fatal outcome. Chewing tobacco is probably worse than smoking it. The detection of one or two such abnormal cells is sufficient to warrant a histological specimen obtained by scalpel biopsy. The histopathology is highly variable, ranging from hyperkeratosis and hyperplasia to atrophy and severe dysplasia. Histological assessment of oral epithelial dysplasia is notoriously unreliable.