Q&A: What is “hairy leukoplakia”? Is it potentially malignant?
Author: Sanketh DS, MDS
Oral hairy leukoplakia(OHL), first reported by Greenspan in 1984, is a white corrugated lesion primarily affecting the lateral borders of the tongue. It is seen in patients with severe immunosuppression, especially in those infected with HIV. OHL is caused by replication and spread of Epstein-Barr virus in the stratum spinosum and granulosum layers of the oral mucosal epithelium.
OHL is strongly associated with HIV and may be the first clinical signs of HIV infection. It mostly occurs bilaterally on the lateral margins of the tongue and may occasionally extend dorsally. It appears as white vertical streaks of keratin or thickened plaques with a shaggy surface. OHL may rarely manifest on the buccal mucosa, floor of mouth and palate.
Microscopy reveals hyperkeratosis, acanthosis and a characteristic band of lightly stained, swollen “balloon cells” in the upper spinous layer. Epithelium is bland and does not reveal dysplasia.
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