An oral leukoplakia (OL) is, according to the World Health Organization (WHO), any predominantly white lesion or plaque of questionable behavior, to the clinical and histopathological exclusion of any other definable white disease or disorder.
Despite being the most frequent potentially malignant oral disorder, its estimated incidence is less than 1% in the general population, affecting mostly men, especially in their fifth decade, while in women it appears in the seventh decade of life.
It is closely related to tobacco consumption, although it can also appear in non-smokers, in these cases we speak of idiopathic leukoplakia.
Classically, LO has been divided according to its clinical features: homogeneous and non-homogeneous, the latter being divided into erythroleukoplakia, nodular and exophytic.
Diagnosis of oral leukoplakia
At first, the provisional diagnosis is clinical when an anamnesis and a thorough oral examination are performed. To reach a definitive diagnosis, a biopsy and histopathological study are necessary.
The rate of malignant transformation of leukoplakia into cancer is variable, although the annual risk of malignancy is around two to three percent.
Proliferative warty leukoplakia
There is a particular form of oral leukoplakia known as “proliferative warty leukoplakia” (PVL) or “proliferative multifocal leukoplakia”, first described by Hansen in 1985.
This is a particularly aggressive form of leukoplakia. It is usually associated with non-smoking women around the sixth decade of life. This leukoplakia is characterized by the presentation of multiple white plaques that grow and spread along the oral mucosa, predominantly affecting the gingiva and jugal mucosa. The most striking clinical features are its multifocality, the long evolution time and the high malignancy rate, higher than 50%.
Treatment of oral leukoplakia
Regarding the treatment of LO and PVL, different therapeutic alternatives have been suggested: conventional surgical removal, CO2 laser surgery and retinoid treatment, among others. For now, none of these treatments have sufficient scientific evidence and have not been shown to be effective in preventing recurrence and malignization of leukoplakia. Our recommendation is to perform strict periodic follow-ups to detect as soon as possible a change in behavior and thus be able to perform a biopsy and an early diagnosis.
Clinical case
This is a 46-year-old female patient who was referred to the Master of Oral Surgery and Buccofacial Implantology of the University of Barcelona for presenting several asymptomatic white lesions in the oral mucosa.
The patient had no medical history of interest and did not report any toxic habits (she did not use tobacco or alcohol). The intraoral clinical examination revealed several homogeneous and non-homogeneous, well-defined and irregular white plaques, although none of the white lesions were detachable on scraping or hard on palpation.
The provisional clinical diagnosis was proliferative verrucous leukoplakia / proliferative multifocal leukoplakia and several biopsies were performed to obtain a histopathologic analysis. With all these data the definitive diagnosis of proliferative verrucous/multifocal proliferative leukoplakia was made. Due to the high risk of malignization of the lesions, it was decided to carry out a strict follow-up plan for the patient with periodic check-ups every 3-6 months and she was instructed in oral self-examination for early detection of any novelty or change in the process.
Conclusions
It is essential to make an early diagnosis of LO before carcinoma occurs. Oral cancer is a frequent malignant neoplasm that occupies the sixth position in frequency with respect to other cancers. Moreover, nowadays it still has a high morbidity and mortality rate, with a five-year survival of less than 50%. These are alarming figures considering the easy accessibility of the oral cavity for clinical examination, which would allow early diagnosis.
The importance of the dentist and oral hygienist in the primary prevention and early diagnosis of potentially malignant oral disorders and oral cancer should be emphasized, as they are the health professionals who have the greatest access to this region.
In addition, it is important to remember that it is essential to perform a biopsy and histopathological study of any oral cavity lesion that is suspicious or does not heal within 15 days.
For more information, consult a specialist in dentistry and stomatology.