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Fig. 1.6. Erythroleukoplakia of the buccal mucosa. The microscopic diagnosis was atypical hyperplasia. Courtesy of Dr. D. Dovsak, Ljubljana, Slovenia

frequently involved sites [47, 263]. OEs that are intermixed with white areas are called erythroleukoplakia or speckled mucosa and are believed to behave similarly to pure OE. The red appearance of OE may be related to an increase in subepithelial blood vessels, a lack of surface keratin and thinness of the epithelium. Prior to a clinical diagnosis of OE numerous entities should be excluded, such as: median rhomboid glossitis, all kinds of injuries, infectious and allergic lesions, haemorrhages, vessel tumours, Wegener's granulomatosis, etc. [47]. Although OE is a rare lesion, it is much more likely to show dysplasia or carcinoma. Shafer and Waldron reviewed their biopsy experiences with 65 cases of OE: 51% of cases showed invasive SCC, 40% were carcinomas in situ or severe dysplasia, and the remaining 9% showed mild to moderate dysplasia [319]. In all red lesions of the oral mucosa that do not regress within 2 weeks of the removal of possible aetiological factors, biopsy is, therefore, mandatory.

does not highlight a particular causal agent and the lesion would appear to be multifactorial [114, 342]. The relatively common absence of well-known risk factors associated with oral cancer and a preponderance of elderly female patients, may indicate a different pathogenesis of PVL-related, compared with non-PVL-relat-ed, cancer [32]. It appears most frequently in the buccal mucosa, followed by the gingiva, tongue, and floor of the mouth [322]. The severity of histologic features correlates with duration of lesion, from benign kera-totic lesion to verrucous hyperplasia, and finally, up to one of three forms of SCC: verrucous, conventional or papillary types [32]. PVL should be considered a possible diagnosis when a specific discrepancy between bland histological features and aggressive clinical course is established [114]. Whether verrucous hy-perplasia forms a separate stage in this series of his-tological features shown by PVL is debatable, as there seems to be considerable histological overlap between this lesion and verrucous carcinoma. Thus, there are no convincing arguments that verrucous hyperplasia is anything other than a variant of verrucous carcinoma [327, 371, 390]. A mean time of 7.7 years was found from the diagnosis of PVL to cancer development in 70.3% of patients [322]. The treatment of PVL continues to be an unsolved problem with high rates of recurrence, since total excision is rarely possible because of the widespread growth [32].

Oral erythroplakia is much less common than OL. OE occurs most frequently in older men as a red macula or plaque with a soft, velvety texture, quite sharply demarcated and regular in coloration. The disease was found to have no apparent sex predilection and is most frequent in the 6th and 7th decades [319].

The floor of the mouth, the ventral and lateral tongue, the retromolar region and the soft palate are the most

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