Photo Rounds

White patch on tongue

A 57-year-old man asked his family physician (FP) to look at a nonpainful white patch that had been on the side of his tongue for the past 7 months. The patient admitted to drinking 2 to 3 beers in the evening and smoking one pack of cigarettes a day. The FP noted a painless white, thick lesion with fissuring on the side of the patient’s tongue.

What's your diagnosis?


This patient was given a diagnosis of leukoplakia and the biopsy indicated that the lesion was premalignant.

The World Health Organization defines leukoplakia as “white plaques of questionable risk” in cases where other known diseases that don’t carry an increased risk for cancer have been excluded. For all types of leukoplakia, the risk of malignant transformation is approximately 1%, with a much higher risk associated with leukoplakias that contain red spots and/or rough spots.

Smoking and alcohol exposure are major risk factors for leukoplakia and create a synergistic effect when combined. Human papillomavirus (HPV) is a recognized risk factor for oropharyngeal cancer, but its association with leukoplakia is undetermined.

All leukoplakias should be excised and biopsied to determine the presence of epithelia dysplasia, carcinoma in situ, or squamous cell carcinoma. In this case, the patient was told that he needed to stop smoking and drinking. He was also referred to an oral surgeon for further evaluation of the dysplasia.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Huber M, Gonsalves W. Leukoplakia. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:249-252.

To learn more about the Color Atlas of Family Medicine, see:

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking this link:

Next Article: