Clinical criteria for identifying early oral and oropharyngeal carcinoma: erythroplasia revisited.

From 1961 to 1981, we evaluated 502 asymptomatic oral and oropharyngeal lesions in a veterans population of tobacco and alcohol users. Three hundred twenty-six cancers (236 invasive and 90 in situ) in 276 patients were recorded and described. For invasive cancers and in situ lesions, 64 percent and 54 percent, respectively, were red or predominantly red. Eleven percent and 16 percent were white only or predominantly white. The invasive cancers were more often granular than the in situ cancers. The traditional clinical characteristics of ulceration, induration (palpability), elevation, bleeding, and associated cervical adenopathy were not usually present in these early lesions. We found leukoplakia to be a variable characteristic as opposed to the almost constant presence of erythroplasia. These findings strongly suggest that it would probably be useful to eliminate the term leukoplakia from the discussion of cancer in a population of tobacco and alcohol users.