Marginal linear gingival leukoplakia progressing to “ring around the collar”—An ominous sign of proliferative verrucous leukoplakia

Abstract

Background Potentially malignant lesions of the gingiva may frequently present as well‐demarcated white lesions confined to the marginal gingiva. These lesions often become thick and verrucoid and spread along the marginal gingiva to encircle the tooth. Some cases of marginal gingival leukoplakia, over time, progress to extensively involve the gingiva fulfilling the criteria for proliferative verrucous leukoplakia (PVL). The objective of this study is to raise awareness of this pattern of leukoplakia by reporting a series of cases of marginal gingival leukoplakia. Methods An Institutional Review Board approved retrospective search of University of Florida and University of Nebraska Medical Center oral biopsy services was performed for all gingival biopsies. Inclusion criteria included cases exhibiting marginal gingival leukoplakia, and with accompanying clinical images. Results A total of 30 cases of marginal gingival leukoplakia were included. All cases presented as well‐demarcated leukoplakias, either on the buccal or lingual gingival margin, or circumferentially forming a “ring around the collar” of single or multiple teeth. Eight patients had recurrent lesions and 12 had multifocal involvement. Six of the 12 patients with multifocal involvement presented with a “ring around the collar.” The histopathologic diagnoses were representative of benign lesions in seven cases, premalignant in 13, and malignant or suggestive of malignancy in 10 cases. Seven patients had carcinoma at the time of first biopsy, whereas 6 cases showed progression at time of follow‐up. Conclusion This study aims to raise awareness that marginal gingival leukoplakia may represent potentially malignant lesions, and if circumferential and/or thick, may be the first manifestation of PVL.

Prognostic outcomes of oral squamous cell carcinoma derived from proliferative verrucous leukoplakia: A systematic review

“…A striking feature of PVL is their multifocal behaviour, affecting several areas of the oral cavity simultaneously, where the buccal mucosa, gingiva, tongue and palate are the most common sites of involvement (Upadhyaya et al, 2021). This multifocal behaviour, associated with frequent recurrences and a high probability of malignant transformation, characterizes the oral mucosa as the described cancerization field.…”

Proliferative Verrucous Leukoplakia Presenting as a Ring Around the Collar and Cancer: A Case Report

“…This localisation is, however, the most frequent, as 50.9% of PVL cases have at least a gingival localisation [6]. It is important to consider this diagnosis when a verrucous form of marginal linear leukoplakia, evolving rapidly, forming a "ring around the collar" of the teeth appears [4]. It is the first and only case of gPVL we observed in our department, which made the diagnosis even more challenging.…”

“…Because of the localisation of the lesion as a "ring around the collar" of all the mandibular teeth [4], a total excision could not be performed, despite the high risk of malignant transformation. Thus, a three-month control interval was established to diagnose the malignant transformation as soon as possible.…”

“…Although the majority of reported oral PVL lesions are often multifocal, gingival-only forms have been recently described [4]. The gingival localisation is one of the most frequent and seems to have a higher malignant transformation rate than other localisations [5].…”

Oral and periodontal manifestation related during human papilloma virus infections: Update on early prognostic factors

“…The oncogenic risk of HPV is related to its proteins, in particular to E6 and E7, in fact, according to their features two groups can be distinguished: the LR-HPVs and the HR-HPV. The first one is associated with benign lesions of skin and mucosa, meanwhile the second one is associated with malignant lesions [ [116] , [117] , [118] ]. The oncogenic role of HR-HPV E6 has an impact in a lot of cellular functions, in fact it binds and degrades tumor suppressor protein p53, blocks the apoptosis, the differentiation of keratinocytes and the interferon responses [ 10 , 116 , 119 ].…”