Precursor lesions have a clinically diverse appearance, variously described as leukoplakia (white patch), chronic hyperplastic laryngitis or rarely erythro-plasia/erythroplakia (red patch). A circumscribed thickening of the mucosa covered by whitish patches, or an irregularly growing, well-defined warty plaque may be seen. A speckled appearance of lesions can also be present, caused by unequal thickness of the keratin layer. However, the lesions are commonly more diffuse, with a thickened appearance, occupying a large part of one or both vocal cords. Their surface is rough, may be muddy brown to red (erythroplasia), perhaps with increased visible vascularity, or coated with diffuse or dispersed circumscribed whitish plaques (speckled leukoplakia) {1253,1332}. Few white patches are ulcerated (6.5%) or combined with erythroplasia (15%) {243}. Leukoplakia, in contrast to erythroplasia, tends to be well demarcated. In general, leukoplakia has a lower risk of malignant transformation than mixed white and red lesions, or speckled leukoplakia, which has an intermediate risk, and pure ery-throplasia which has the highest risk of cancer development {2759}. However, no one clinical appearance is reliably diagnostic of any histologic grade of precursor lesion. Occasionally precursor lesions may appear clinically normal.

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