口腔白斑

口腔白斑表现为风险不确定的白斑，在排除其他无口腔癌变风险的已知病变或疾病后即可诊断。

临床上根据病损特征，可分为：均质型、颗粒状、结节状和疣状白斑

可表现为特发性，但常见于重度烟草使用者、饮酒者和槟榔果（槟榔咀嚼块）食用者。

大部分白斑在组织学上呈良性，具有多种组织学特征。异型增生分级有助于选择治疗方案。

某些白斑（特别是非均质型白斑，例如颗粒状白斑和疣状白斑）具有显著的恶变风险。需予行为习惯干预及频繁仔细的随访，且随着时间的推移通常需要行活检确诊或明确白斑的生物学性质。

根据世界卫生组织 (WHO) 的传统定义，口腔白斑是一种发生于口腔黏膜上以白色为主的损害，且不能诊断为其他任何可定义的疾病。[1]Kramer IR, Lucas RB, Pindborg JJ, et al. Definition of leukoplakia and related lesions: an aid to studies on oral precancer. Oral Surg Oral Med Oral Pathol. 1978 Oct;46(4):518-39. http://www.ncbi.nlm.nih.gov/pubmed/280847?tool=bestpractice.com [2]Axell T, Holmstrup P, Kramer IRH, et al. International seminar on oral leukoplakia and associated lesions related to tobacco habits. Community Dent Oral Epidemiol. 1984 June;12(3):145-54.[3]Axell T, Pindborg JJ, Smith CJ, et al. Oral white lesions with special reference to precancerous and tobacco-related lesions: conclusions of an international symposium held in Uppsala, Sweden, May 18-21 1994. International Collaborative Group on Oral White Lesions. J Oral Pathol Med. 1996 Feb;25(2):49-54. http://www.ncbi.nlm.nih.gov/pubmed/8667255?tool=bestpractice.com 虽然特发性白斑并不罕见，但白斑常与吸烟相关。[2]Axell T, Holmstrup P, Kramer IRH, et al. International seminar on oral leukoplakia and associated lesions related to tobacco habits. Community Dent Oral Epidemiol. 1984 June;12(3):145-54.[3]Axell T, Pindborg JJ, Smith CJ, et al. Oral white lesions with special reference to precancerous and tobacco-related lesions: conclusions of an international symposium held in Uppsala, Sweden, May 18-21 1994. International Collaborative Group on Oral White Lesions. J Oral Pathol Med. 1996 Feb;25(2):49-54. http://www.ncbi.nlm.nih.gov/pubmed/8667255?tool=bestpractice.com 一个国际工作小组对此前的 WHO 定义进行了如下修改：“口腔黏膜白斑病”这一术语应该用来表示具有可疑风险的口腔黏膜白色斑片，排除无癌症风险的（其他）已知疾病或异常。[4]Warnakulasuriya S, Johnson NW, van der Waal I. Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med. 2007 Nov;36(10):575-80. http://www.ncbi.nlm.nih.gov/pubmed/17944749?tool=bestpractice.com [5]Warnakulasuriya S, Kujan O, Aguirre-Urizar JM, et al. Oral potentially malignant disorders: a consensus report from an international seminar on nomenclature and classification, convened by the WHO Collaborating Centre for Oral Cancer. Oral Dis. 2021 Nov;27(8):1862-80. http://www.ncbi.nlm.nih.gov/pubmed/33128420?tool=bestpractice.com ​

白斑通常为均质型，且大多为良性。非均质型白斑（也称为红白斑，如颗粒状白斑和结节状白斑）的恶性风险更高，其病变主要为白色或红白色，质地不均，可呈扁平状、结节状、外生型或乳头状/疣状。两类白斑均有多种组织学特征，如正角化或不同程度的角化不全、轻度炎症以及不同程度的上皮异型增生。然而，尽管 WHO 已定义了异型增生的标准，但评估中观察者间和观察者内差异大，所以很难客观地对异型增生进行分类。[6]El-Naggar AK, Chan JKC, Grandis JR, et al, eds. WHO classification of head and neck tumours. 4th ed. Lyon, France: International Agency for Research on Cancer; 2017.[7]Speight PM, Khurram SA, Kujan O. Oral potentially malignant disorders: risk of progression to malignancy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Jun;125(6):612-27. https://www.oooojournal.net/article/S2212-4403(17)31248-8/fulltext http://www.ncbi.nlm.nih.gov/pubmed/29396319?tool=bestpractice.com