Oral Erythroplakia: Past, present and future aspects

To critically review the current evidence on oral erythroplakia (OE), a rare but clinically significant oral potentially malignant disorder (OPMD), with particular emphasis on its malignant transformation rate, diagnostic challenges, and controversies surrounding its classification and management.

A comprehensive literature review was conducted across Medline/PubMed, SCOPUS, Web of Science, and EMBASE. Studies published up to June 2026 with full text available in English were considered. Then, evidence was synthesized narratively.

OE is considered to have one of the highest malignant transformation rates among OPMDs, with most lesions demonstrating severe epithelial dysplasia, carcinoma in situ, or invasive carcinoma at initial biopsy. Molecular evidence supports early and extensive oncogenic change, frequently in the context of field cancerization. Histopathological heterogeneity and the absence of universally accepted diagnostic criteria continue to hamper clinical decision-making and inter-study comparability.

OE remains poorly understood and inadequately managed, largely due to the lack of standardized diagnostic criteria, validated prognostic biomarkers, and controlled clinical trials. Given its aggressive biological behavior, early biopsy, rigorous histopathological assessment, and long-term surveillance are mandatory. Clinicians must recognize that OE may represent, in many cases, an already established carcinoma rather than a conventional OPMD.