A white patch visible on the cervical epithelium even before application of acetic acid is known as leukoplakia. The white patch is due to deposition of keratin in the epithelial cells. Leukoplakia can be induced by HPV infection or may be idiopathic. Cervical neoplasms (high-grade lesions or cancer) can also induce keratin deposits on the surface and appear as leukoplakia patches. Leukoplakia can hide high-grade premalignant lesions or even cancer underneath. All leukoplakia patches in the transformation zone of the cervix should be biopsied or excised. Typically, leukoplakia appears as a white plaque on the cervix, with a shiny, waxy surface and a sharp, raised margin.
Leukoplakia due to high-grade precancerous lesions or cancer will always be in the transformation zone. The leukoplakia may peel-off during examination and reveal coarse mosaics or coarse punctation at the base. If the leukoplakia is due to cervical neoplasia, further dense white areas will appear after application of acetic acid.