A retrospective study: The demographic characteristics of patients who received a diagnosis of oral leukoplakia, their oral clinical and histopathological features and the relation with each other in the lesions inside the mouth and face in Ege University (egeya) council

Oral leukoplakia (OL) is defined as "After ruling out other white diseases and disorders as clinically and histopathologically, a predominantly white lesion or plaque which has questionable behavior with a diagnosis can be made". It is the most common precancerous lesion which is encountered in the oral mucosa. The OL, which is reported prevalence rates are 1,7-2,7%, is more commonly seen in men and in over the age of 40 as a result of the habit of smoking. Its etiology is multifactorial. Smoking is the most frequently held responsible factor in etiology. Other risk factors are located as alcohol, human papilloma virus (HPV), dental restoration, mechanical irritation, Candidiasis, serum vitamin A and the significant decrease in the levels of beta carotene. While it can settle any localization in the mouth, the most frequent localization is the buccal mucosa. According to the surface characteristics of the lesions OL, there are two main clinical types: Homogeneous and Nonhomojen OL. There are two main types of homogeneous lokoplak: Thin, straight and thick, fissured leukoplakia. Nonhomojen OL is grouped as erythroplakia, verrucous and nodular according to their clinical appearance. Proliferative verrucous OL, which is sub-type of verrucous OL, has a separate significance with presenting clinic aggressive, multifocal placement, treatment-resistant, high recurrence rate and malignant transformation. All lesions, which is thought clinically as OL, histopathological sampling should be done. OL histopathological appearance, which is not accompanied by dysplasia, changes from squamous hyperplasia till severe dysplasia. The presence of dysplasia, is accepted as the most important risk factor in terms of malignant transformation. The malignant transformation in OL is reported at the rate of 0,13-17,5%. OL can be monitored without giving treatment according to factors such as clinical type, location, histopathological features or can be treated with medical and surgical methods. Surgical treatment options are conventional surgical excision, laser surgery (excision or evaporation), electrocoagulation or cryotherapy. Medical treatment options regard A, C and E vitamins, systemic β-carotene, lycopene, retinoids, ketorolac, local bleomycin, and photodynamic therapy. In our study, the patients, who are the diagnosed with oral leukoplakia as clinically and histopathologically, were evaluated retrospectively through the patient information forms and the Council photo archives between the years 2007-2015 in EGEYA Council. Epidemiological, clinical, histopathological features and applied treatment methods of this disease were evaluated in detected 79 OL patients. The patients who participated in our study, 40% were male (50,6%), 39% were female (49,4%) and their average age was 58,73(±17,952). 57% (n=45) of the patients, who were taken to the study, were smoking. The amount of average cigarette usage was 28,44 ± 34,625 package/year. The habit of chewing tobacco existed in 3,8% (n=3) of the patients. Chronic alcohol usage existed in 27,8% (n=22) of the patients. The oral hygiene was found to be bad in 68,4% (n=54) of the patients. Amalgam fillings existed %35,4 (n=28) of the patients. Mycological examination was made 27,9% (n=22) of the patients and 19% (n=15) overgrowth of Candida albicans revealed. In our study, OL lesions were most frequently (31,6%) located on the buccal mucosa. Secondly it located to the tounge mostly (29,1%), then, with the addition it occured in gingival (11,4%), hard palate (%7,6), soft palate (6,3%), floor of the mouth (6,3%) and labial mucosa (2,5%). While Homogeneous OL was seen in 49,4% (n=39) of the patients, Nonhomojen OL was seen in 50,6% (n=40) of the patients. While 35,4% (n=28) of Homogeneous OL was thick fissured OL , 13,9% (n=11) percent was thinn and flat OL. Nonhomojen OL patients were the type of 22,8% (n=18) granular nodular, 11,4% (n=9) verrucous, 10,1% (n=8) erythroplakia, 6,3% (n=5) proliferative verrucous. As a result of histopathological examination of biopsy specimens which are taken from the lesions, 46,8% (n=37) squamous hyperplasia (SH) and hyperkeratosis, 15,2% (n=12) squamous intraepithelial neoplasia 1 (SIN1), %21,5% (n=17) SIN2, 15,2% (n=12) SIN3, 3,9% (n=3) squamous hyperplasia + SIN1, and as the result of SIN2 + SIN3 1,3% (n=1) were identified. With these results, 48,1% (n=38) of the patients underwent conventional surgical treatment, 13,9% (n=11) medical treatment and 8,9% (n=7) cryotherapy. In addition, 6,3% (n=5) of the patients were quitted smoking, 6,3% (n=5) amalgam change was made, 3,8% (n=3) oral hygiene was maintained, 3,8% (n=3) was followed up closely without giving treatment, 2,6% (n=2) was quitted smoking and provided oral hygiene, 2,6% (N=2) medical treatment and smoking cessation, 1,3% (n=1) cryotherapy and smoking cessation, 1,3% (n=1) was provided smoking cessation, oral hygiene and amalgam replacement, 1,3% (n=1) amalgam was changed, was maintained and attendantly underwent medical treatment. The area cancerization is detected 7,8% (n=6) of the patients. The patients who is detected with the area cancerization were diagnosed with 5,2% (n=4) carcinoma of the tongue, 1,3% (n=1) lung carcinoma, 1,3% (n=1) carcinoma in situ of tonsil, hypopharynx and SHK in epiglotit, carcinoma in situ of the larynx. There was no significant difference between the clinical types of lesions and the etiologic factors, histopathologic results and treatments applied. This statement is associated with the small number of patients and having a lot of parameter are caused to the reduction of the rate. Key words: Oral Leukoplakia, Epidemiology, Histopathology, Treatment, Area Cancerization