Erythroplakia (Red Spots in Your Mouth): Could It Mean Cancer?

Erythroplakia (Red Spots in Your Mouth): Could It Mean Cancer?
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Erythroplakia (Red Spots in Your Mouth): Could It Mean Cancer?Clinical Content Reviewed by Dr. Jay Khorsandi, DDS
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Table of Contents

  1. Defining Erythroplakia
  2. Causes
  3. Risk Factors
  4. Symptoms
  5. Is It Painful?
  6. Diagnosis
  7. Is It Cancer?
  8. Treatment Options
  9. Prevention
  10. References
It's normal to experience some form of mouth discomfort from time to time. But what if it’s an annoying red spot on your mouth or tongue? Should you ignore it or hope it disappears by itself?
If this spot wasn’t caused by an abrasion, a burn or some other trauma, you might want to visit your dentist. It could be something more dangerous and should be assessed by an orthodontist.

These sore spots in the mouth are called oral lesions, a catch-all term that includes three categories: leukoplakia, erythroplakia and or erythroleukoplakia. The red spots are erythroplakia, precancerous marks that often go away on their own but should be looked at by a qualified doctor.

The same goes for any oral lesions that you see in your mouth, especially if they consistently recur.

Defining Erythroplakia

The American Cancer Society defines erythroplakia, leukoplakia and erythroleukoplakia a change of oral tissue that results in red patches, which bleed if scraped. A healthy mouth should be brown or pink, and areas that appear to white, red or black bear investigating.

The three types of lesions are different because of their look:

  • Erythroplakia: Red spots in the mouth that bleed easily
  • Leukoplakia: White or gray patches in the mouth
  • Erythroleukoplakia: A blended lesion that has white (leukoplakia) and red (erythroplakia) spots or patches in the mouth.

Most Erythroplakia lesions appear on the tongue or on the floor of your mouth, and they cannot be scraped away.

Causes of Erythroplakia

Erythroplakia is caused primarily by an injury to the mouth tissue or a disease attack in the mouth. Lesions usually appear inside your cheek, under the tongue or sometimes on the palate.

It may not present with any other symptoms, and you may only realize it if you take a closer look at your mouth.

Erythroplakia Potential Risk Factors

There are many risk factors associated with this oral condition. They include:

  • Age and gender of an individual: Erythroplakia is primarily common in men aged 60-70 years. This makes these older patients more susceptible to cancer due to these premalignant lesions.
  • Smoking: All smokers typically develop oral lesions and are highly at risk of developing this precancerous condition. The condition is even more prevalent in women who smoke.
  • Excessive alcohol consumption: Excessive drinking has been attributed to the development of oral lesions.
  • Secondary infection or oral yeast infection: superinfection with candidiasis can be linked to the growth and development of erythroplakia lesions. In some cases, the lesions may not be cancerous and can be eliminated with antifungal medication.

Common Erythroplakia Symptoms

Erythroplakia symptoms are straightforward to detect, especially if you inspect your mouth often. The condition shows up as a mostly red patch that doesn't go away on its own even after some time.

It's easy to dismiss erythroplakia in its early stages unless it comes with severe symptoms, such as:

  • Mouth sensitivity to hot foods
  • Aching and soreness
  • Painful throbbing sensation

Any throbbing may be because of underlying inflammation that indicates a different kind of issue involvement and won’t necessarily be erythroplakia. If you have a burning sensation, that may stem from a neural issue. For example, peripheral neuropathy can trigger pain areas that indicate nerve disorder, one that results in the patches.

Is an Erythroplakia Lesion Painful?

Most erythroplakia lesions are not painful, and you may not know that you have one unless you inspect your mouth.

In this case, pain is a sign of something severe that needs to be checked out. Pain could be a sign of an underlying cancer.

How Is Erythroplakia Diagnosed?

Diagnosing erythroplakia involves an extensive examination of your mouth and tissues and likely an analysis of one or more tests. After a visual exam of your mouth, gums, tongue and throat, your doctor will likely palpate your neck and throat to check for swelling. They could also take your temperature to check for a fever.

Your dentist may also turn to X-rays and CT scans. It’s possible you’ll need to undergo a biopsy , which will remove one or more pieces of tissue that will be examined for presence of carcinoma. Doctors will want to note any signs of:

  • Trauma
  • Vasodilation and vascular proliferation
  • Leaking of the blood vessels
  • Thinning in the epithelial

Doctors often struggle to diagnose erythroplakia in its early stages because it tends to be asymptomatic. Plus, not every red patch in your mouth is a precancerous lesion. It’s possible the lesions are candidiasis or stomatitis.

Is Erythroplakia an Oral Cancer?

Erythroplakia lesions are considered precancerous, meaning there's an increased chance you can contract cancer from the cells in the red patches. One study from Canada reports that about 50 percent of these red patches develop into squamous cell carcinoma, a type of oral cancer.

Often a red lesion will disappear after someone uses an antifungal spray as a treatment. If they do go away, that’s a sign that the lesions are not cancerous.

Treatment Options for Erythroplakia

Once a diagnosis is confirmed, your dentist or orthodontist will recommend treatment options. One potential option is surgery to remove any oral lesions permanently. There are three types of procedures:

  • Traditional surgery: a doctor uses a scalpel to cut out the lesions
  • Laser surgery: a heated laser performs bloodless cuts to remove the lesions
  • Cryosurgery: a doctor freezes tissues, which will die over a short period of time and peel away

How Do You Prevent Erythroplakia?

If you develop erythroplakia, it could be an indication that you’re not exercising proper oral hygiene. Regular brushing and flossing are a start:

  • Brush your teeth at least twice a day. Doctors recommend brushing each morning and again each evening before bed. That’s because bacteria form in your mouth anyway, and especially when we are not drinking water. Brushing is also important as you advance in age.
  • Floss at least once a day. This is recommended because it removes food particles and bacteria logged in your teeth that brushing may not remove.
  • See your dentist twice a year. Most dental insurance provides coverage for two visits a year. Take advantage of this. Trips to the dentist not only mean regular teeth-cleaning but also give you access to one or more qualified medical professionals who could detect signs of erythroplakia early on.

In short, the best treatment for erythroplakia is prevention through the development of sound oral hygiene habits.


Risk Factors for Multiple Oral Premalignant Lesions. (November 2003). National Library of Medicine.

Assessing Oral Malignancies. (April 2002). American Family Physician.

Surgical Treatment of Premalignant Lesions of the Oral Mucosa. (1987). International Journal of Orang Maxillofacial Surgery.

How Erythroplakia Relates to Oral Cancer. Colgate.

Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to serve as dental or other professional health advice and is not intended to be used for diagnosis or treatment of any condition or symptom. You should consult a dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.