Non-Homogeneous Leukoplakia — ORE Part 1 MCQ

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ModerateOral MedicineNon-Homogeneous LeukoplakiaORE Part 1

A 62-year-old man presents with a white patch on the ventral surface of his tongue. It is thick, nodular, and has interspersed red areas. He has a 40-year smoking history. What term best describes this lesion?

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Correct answer: A — Non-homogeneous (speckled) leukoplakia

Explanation lettering: E = shown as B · D = shown as C · B = shown as D · C = shown as E

The key diagnostic feature is the presence of interspersed red areas within a white patch. Non-homogeneous leukoplakia is defined by mixed white-and-red changes (erythroleukoplakia/speckled leukoplakia), subdivided into speckled, granular, or nodular variants based on the pattern of intermixed erythroplasic components. The thick, nodular morphology confirms non-homogeneous rather than flat appearance. Homogeneous leukoplakia (B) would be purely white; erythroplakia (C) would be predominantly or entirely red with no white component; oral lichen planus (D) is a distinct lichenoid entity with a lacy or striated pattern, not a leukoplakia; frictional keratosis (E) is benign white keratosis secondary to mechanical irritation, without red areas or association with smoking as a primary factor. The ventral tongue location and smoking history are additional high-risk features, reinforcing the need for urgent incision biopsy and assessment of dysplasia grade.

Reference: van der Waal I, Reichart PA, Shear M, Speight PM. Oral leukoplakia; a proposal for simplification and consistency of the clinical classification and terminology. Oral Dis. 2019;25(8):1988-1994 [PMC6901141]; RCS Faculty Dental Journal. Oral white lesions: who, what, where, when, how and why? 2024 [rcseng.ac.uk], https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901141/