Unveiling the Lipid Paradox in Oral Leukoplakia: Metabolic Signatures of Dysplasia and Disease Progression

Abstract

Oral Leukoplakia (OLK) is the most prevalent oral potentially malignant disorder with an increased risk of malignant transformation. Altered lipid metabolism, often driven by tobacco-induced oxidative stress, may contribute to oral carcinogenesis. However, the relationship between serum lipid profiles and OLK remains ambiguous. This study aimed to evaluate lipid profiles across OLK subtypes and their association with dysplasia and tobacco use to their assess diagnostic and prognostic potential. This cross-sectional prospective study included 114 participants, 57 clinically and histologically confirmed OLK cases and 57 healthy controls. OLK cases were categorized into homogeneous OLK, erythroleukoplakia, verrucous OLK, and OLK with oral submucous fibrosis (OSMF) and their dysplastic status was also evaluated. Serum lipid parameters (TC, TG, HDL, LDL, VLDL) were measured. Statistical comparisons were performed using Mann–Whitney U and Kruskal–Wallis tests (p < 0.05). Although OLK patients showed higher mean lipid levels than controls, the differences were not statistically significant (p > 0.05). Among OLK subtypes, significantly elevated levels of TC, TG, LDL, and VLDL were found in homogeneous OLK, while the lowest levels were observed in erythroleukoplakia (p < 0.00). Lipid levels were significantly lower in dysplastic lesions (p < 0.001). Patients with tobacco use > 5 years had higher TC and LDL levels (p < 0.05), whereas habit frequency showed no significant association. Serum lipid alterations, particularly reduced TC, TG, LDL, and VLDL in dysplastic and high-risk OLK variants, may serve as non-invasive prognostic biomarkers for early risk assessment. © Association of Otolaryngologists of India 2025.