Proliferative verrucous leukoplakia: An update

Abstract

Proliferative verrucous leukoplakia (PVL) is a rare form of oral leukoplakia, which was first described in 1985 by Hansen et al. Since then, various published case series have presented PVL as a disease with aggressive biological behavior due to its high probability of recurrence and a high rate of malignant transformation, usually higher than 70%. PVL is a long-term progressive condition, which is observed more frequently in elderly women, 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 with a progressive deterioration of the lesions, making it more and more difficult to control. Tobacco use does not seem to have a significant influence on the appearance or progression of PVL and may occur both in smokers and nonsmokers. Prognosis is poor for this seemingly harmless-appearing white lesion of the oral mucosa. At present, the etiology of PVL remains unclear as well as its management and diagnosis, which is still retrospective, late and poorly defined, lacking consensus criteria. This short review discusses the clinical and histopathological features, diagnosis, traditional treatment and the current management of the disease.

Oral potentially malignant disorders: risk of progression to malignancy

“…Current evidence indicates a higher frequency in older females (>60 years of age), with the gingiva being the most commonly involved site, followed by the buccal mucosa and the tongue. 81,[84][85][86] Gingival and palatal lesions are also the most likely to undergo malignant transformation. 84,87,88 The etiopathogenesis is poorly understood, and there appears to be no correlation with alcohol consumption, tobacco chewing, smoking, or HPV infection.…”

“…84,87,88 The etiopathogenesis is poorly understood, and there appears to be no correlation with alcohol consumption, tobacco chewing, smoking, or HPV infection. 81,84,85 The overall mortality rate is also somewhat unclear, with some studies reporting a 5-year survival rate of 60%, whereas others have suggested it to be less aggressive. In their review, Pentenero et al 84 estimated an overall mortality rate of 30%.…”

Oral White Lesions: An Updated Clinical Diagnostic Decision Tree

“…The mean age of patients with long-lasting lesions of PVL was reported over 60 years [4,5,34,37]. While the etiology of this condition is uncertain genetic factors and viral infections such as Human Papilloma Virus especially type 16 and 18 and Epstein-Barr Virus have been proposed [36,37]. Clinical appearance in the early stage contains small whitish and well-defined patches or plaques appearing as focal and homogeneous keratotic lesions (Figure 10).…”

“…The lesions enlarge slowly and constantly over time involving diffuse surfaces of the mucosa. Meanwhile, non-homogeneous multifocal areas with speckled and rough surface might appear in the form of exophytic, wart-like, verrucous, polypoid projections or erythematous features [5,34,36,37]. PVL usually develops bilaterally, which affects the buccal mucosa, gingivae, and alveolar ridges.…”

Uso da inteligência artificial na caracterização nuclear e classificação entre leucoplasia bucal e leucoplasia verrucosa proliferativa

“…Caso existam diferenças nucleares detectadas entre as LBs e LVPs, essas diferenças podem carregar importantes informações preditivas de transformação para ambas as lesões inclusive, embora isso não será uma questão a ser respondida com esse trabalho. Além disso, pelo fato de a LB ser a DBPM mais comum da cavidade bucal, o impacto que um modelo preditivo que ajude diferenciá-la de uma LVP será de grande importância, pois cada lesão apresenta uma abordagem terapêutica específica e riscos distintos de transformação maligna.Um outro fator importante desse estudo é diagnóstico mais exato de uma LVP, pois na literatura os critérios de diagnóstico são clinicopatológicos, mas dotados de muita subjetividade e com critérios morfológicos muitas vezes difíceis de serem aplicados dada a natureza evolutiva da lesão clinicamente(MUNDE;KARLE, 2016). Como consequência, uma LVP em estágio inicial pode ser confundida com uma LB histologicamente e sem qualquer alteração histológica indicativa de progressão, fazendo com que essa lesão seja frequentemente diagnosticada apenas no estágio avançado, quando os aspectos clinicopatológicos são mais exuberantes.…”