This prospective study was conducted to determine the significance of erythroplasia (red) versus leukoplakia (white) in the diagnosis of asymptomatic oral carcinoma and to accurately record the appearance of the erythroplastic lesion. Persistent asymptomatic lesions in any portion of the oral cavity, except the lip, that were considered clinically suspicious with our previous criteria (erythroplasia), or those changes that did not correspond to the visual criteria but were found in high risk sites, were studied and biopsies were performed. Degrees of redness versus whiteness and clinical diagnoses were documented. Of 148 lesions in 113 patients, 66 were malignant (52 invasive and 14 in situ). There was a false negative diagnostic rate of 4.5% (3 of 66) and a false positive rate of 7% (4 of 57). Of the malignant lesions, 86.3% were primarily red compared with 31.9% of the benign lesions. OF the cancers, 10.7% were predominantly white as opposed to 66.7% of benign lesions. This analysis confirms our previous suppositions that persistent erythroplasia rather than leukoplakia, in high-risk sites of the oral cavity, is the earliest and predominant sign of oral carcinoma.

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