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Non-homogenous leukoplakias carry a higher risk of OSCC development compared to homogeneous leukoplakias there is an approximately 7-fold increase risk for malignant development with non-homogeneous leukoplakia compared with homogeneous leukoplakia and a 5-fold increase in risk when the lesion size is greater than 200 mm 2 In Western populations, elderly females with long-standing idiopathic leukoplakia, with no risk factors, paradoxically, have an increased risk of progression to cancer probably due to an endogenous risk factor rather than environmental factors