Oral leukoplakia and proliferative verrucous leukoplakia: a review for dental practitioners

Abstract

Objectives To provide an overview of the current thinking in terms of the diagnosis and management of oral leukoplakia and proliferative verrucous leukoplakia as relevant to general dental practitioners.Data sources, data selection, data extraction, data synthesis We searched the MEDLINE Ovid, EMBASE databases and the Cochrane Library, (1990 to 16 April 2017), restricting our search to English language with the following key words: leukoplakia, white patch, proliferative verrucous leukoplakia, precancerous lesion, premalignant lesions, potentially malignant oral conditions and potentially malignant oral disorders. The two authors selected key papers and engaged in collaborative data extraction and synthesis of the selected reference material.Conclusions General dental practitioners (GDPs) are likely to encounter patients with a known or yet undiagnosed oral leukoplakia in their clinical practice. The diagnosis is clinically based as there are no pathognomonic histopathological features. The definition of leukoplakia has evolved over the years. The importance of recognition and appropriate management relating to this condition is described particularly as it is one of the oral potentially malignant lesions. The inferred increased risk of malignant transformation is well documented however controversy still persists in terms of the appropriate management for these lesions. Proliferative verrucous leukoplakia is a recalcitrant, often widespread and multifocal distinct type of leukoplakia. It is considered to have a high rate of malignant transformation with implications in terms of lifelong monitoring both clinically and histopathologically. A high index of suspicion is important for general dental practitioners in order to identify such lesions that would require onward referral for further investigation and management.

tAF-MUSICAL: Autofluorescence Super-resolution Microscopy for Molecular Histopathology of Matrix Proteins in Fibrotic Diseases

“…The patchy labeling is due to modification of the binding site on keratin protein or its condensation, causing the masking of keratin epitopes, rendering it unavailable for labeling. The immunostained OLKP tissue shows almost half the occurrence of keratin found in epithelium-proper due to incomplete labeling in the parakeratinized layer (Fig 6j), which contrarily is heavily keratin-dense (28). As labeling artifacts do not limit tAF-MUSICAL, we observed the para-keratinized layer to have a 2-fold higher keratin expression than epithelium proper (Fig 6 c,i).…”

Oral cancer on the gingiva in patients with proliferative leukoplakia: A study of 30 cases

“…Staines and Rogers described PL as a distinct widespread, multifocal type of leukoplakia with a tendency to progressively involve most areas of the oral mucosa. As many PL cases evolve to OSCC, patients with PL require regular lifelong follow‐up, with strict clinical reviews and multiple biopsies.…”

“…General dental practitioners should also be aware of PL, and should refer patients in whom they have detected it to specialized professionals for precise diagnosis, and adequate management and follow‐up …”

Oral Cancer: Raising Awareness of the Importance of Suspicion in Early Detection

“…Proliferative verrucous leukoplakia (PVL) is a rare and aggressive form of oral leukoplakia, with a high rate of malignant transformation and progression to proliferative verrucous carcinoma (PVC). 14 It begins as a white hyperkeratotic plaque which spreads and becomes multifocal. With time the lesion produces exophytic, wart-like areas that become carcinomas.…”