Oral proliferative verrucous leukoplakia: A case report with an update

Abstract

White lesions both physiologic as well as pathologic are relatively frequent in the oral cavity, the most common pathology being oral leukoplakia (OL). There are many variants of OL, one of which is oral proliferative verrucous leukoplakia (OPVL). OPVL is a rare clinico-pathological entity, which is slow growing, long-term progressive lesion, but remains an enigmatic and difficult to define. The etiology of OPVL remains still unclear. Tobacco use does not seem to have a significant influence on the appearance of OPVL. These lesions may occur both in smokers and non-smokers. It is observed more frequently in women and elderly patients over 60 years at the time of diagnosis. The buccal mucosa and tongue are the most frequently involved sites. It develops initially as a white plaque of hyperkeratosis that eventually becomes a multifocal disease with confluent, exophytic and proliferative features. Various published case series have presented OPVL as a disease with aggressive biological behavior due to its high probability of recurrence and a high rate of malignant transformation. Prognosis is poor for this seemingly harmless-appearing white lesion of the oral mucosa. This article describes the clinical aspects and histologic features of an OPVL case that demonstrated the typical behavior pattern in a long-standing, persistent lesion and discusses this relatively rare entity in light of current information.

Potentially malignant disorders revisited—The lichenoid lesion/proliferative verrucous leukoplakia conundrum

“…Histopathologically, PVL is known to exhibit a continuum of morphological change, passing through an initial hyperkeratosis phase usually without dysplasia, through verrucous hyperplasia leading on to verrucous carcinoma and invasive OSCC . Complicating the early phase of PVL is the presence of lymphocytic infiltrates in the immediate subepithelial region similar to OLL . It is not an unreasonable hypothesis, therefore, that OLL and PVL may be part of the same PMD continuum.…”

“…18 Complicating the early phase of PVL is the presence of lymphocytic infiltrates in the immediate subepithelial region similar to OLL. 9,17,19 It is not an unreasonable hypothesis, therefore, that OLL and PVL may be part of the same PMD continuum.…”

Oral precursor lesions and malignant transformation – who, where, what, and when?

“…17 It is also of interest that early-phase, proliferative, verrucous leukoplakia, which ultimately progresses to multifocal, exophytic, proliferative lesions (that have the potential for aggressive malignant transformation), is now known to share some of the histopathological features of lichenoid lesions such as subepithelial lymphocytic infiltration, basal cell degeneration, apoptosis, and eosinophilic body formation, so diagnosis remains complex. 18 …”

Diode laser: In treatment of recurrent verrucous leukoplakia

“…Laser ablation reportedly has been successful in a very small group of patients followed for 6–178 months. [ 12 ]…”