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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Investigations Biopsy of clinically suspected oral leukoplakia is mandatory for two reasons: To exclude other conditions such as lichen planus If the lesion is OL, to assess for the absence or presence, and grade of dysplasia - the presence of dysplasia, carcinoma-in-situ and invasive carcinoma cannot always be predicted clinically The degree of dysplastic change reported on histology is regarded as the most important factor in determining the cancerous potential of OL, however, it is important to note that dysplastic lesions can resolve spontaneously and some cases reported as non-dysplastic may develop into cancer Management Patients should be referred urgently (two-week wait) to an appropriate Secondary Care department eg Oral and Maxillofacial Surgery (refer to local guidelines) All patients should be advised to avoid aggravating habits eg smoking, significant alcohol consumption and trauma Following biopsy a decision will then be taken as to whether to treat the lesion (usually surgical excision) or observe - overall about 2-5% of OL will become cancerous over a ten year period, however, the risks are greater in certain groups Lifelong follow-up is recommended , whether or not the lesion has been treated Disclaimer - the author PCDS cannot accept responsibility for any misleading or incorrect statements, and the management of individual patients remains the direct responsibility of the individual doctor