Leukoplakia Calls for Biopsy

Q:  I have had actinic keratoses for about 15 years and have had to have small lesions removed 3 or 4 times a year. About 4 years ago I noticed a white spot on my lower lip and immediately told my doctor, who said nothing about it, until last year when he called it "leukoplakia."

I now have a very noticeable white swelling on my lower lip and have gone to six dermatologists. Each one did try to help me in some way. In the meantime, it is getting worse by the week, and I now have on my inner lower lip small bumps (like concealed pimples) and it is also starting on my inner left cheek. Please help me to decide what to do next. I am getting desperate.

A:  Leukoplakia means literally "white plaque," and is commonly found anywhere in the mouth – on the gums, inside the cheek, on or under the tongue, on the roof of the mouth or below the lips. The spots can be tiny or as large as a quarter; they are not cancerous but could indicate a pre-cancerous condition arising from chronic irritation. They might eventually become rough textured and sensitive to touch, heat, spicy foods or other irritations.

According to Steven Sewall, DDS, Associate Professor and Chief of Oral and Maxillofacial Surgery at the Medical College of Wisconsin, leukoplakia on the lip is most often due to solar-induced damage from repeated sun exposure. This fits in with your history of actinic keratoses, which are precancerous lesions also caused by sun exposure.

Leukoplakia is also seen in smokers because of chronic heat irritation from the cigarette or pipe. A bad habit of biting the inside lip could also result in a lesion. Dr. Sewall said that chewing tobacco or snuff, which has become popular among high school boys and girls, is also a cause of leukoplakia inside the cheek.

Because of the possibility of early cancer, a biopsy is probably indicated. You could see an oral surgeon, ear nose and throat specialist, plastic surgeon, or dermatologist for their recommendations.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.