Keratosis is a lesion seen most often on the mucosa of the vocal cords. It typically appears as a white patch of leukoplakia. Histologically one sees heaping up of the surface layer of cells, which do not mature and “slough off” as they should.
Leukoplakia vs. Keratosis: What’s the Difference?
These two terms often come up when we talk about white patches on the vocal cords or other parts of the larynx—but they refer to different perspectives.
Leukoplakia is a clinical term. It simply means “white patch,” and it’s what we see during an exam—either with the naked eye or through a scope. Leukoplakia itself isn’t a diagnosis—it’s a description. The underlying cause could be benign, pre-cancerous, or even malignant. That’s why we look closely.
Some leukoplakia appears bland and smooth, with no visible red flags. Other times, the patch may have features that raise concern—like stippling, irregular surface, or corkscrew-shaped capillaries—which can suggest dysplasia(abnormal, pre-cancerous cell changes) or even carcinoma in situ (very early cancer that hasn’t yet invaded deeper tissues).
Keratosis, on the other hand, is a pathological term—used by the pathologist who examines the tissue under the microscope. It describes what’s actually happening at the cellular level. In keratosis, the upper layer of cells—the ones that are supposed to slough off—don’t. They build up instead, forming a visible white plaque. That buildup of retained keratin is what gives leukoplakia its white appearance during the exam.
In short:
- Leukoplakia is what we see (a white patch),
- Keratosis is what we find (keratin buildup under the microscope),
- and Dysplasia or carcinoma in situ are what we worry about—and sometimes discover—when the white patch looks suspicious or is biopsied.
- And the response? A biopsy is often advisable, and if the leukoplakia persists or recurs (which it often does), at a minumum, the lesion should be re-examined regularly.