Dermatologic Manifestations of Oral Leukoplakia Treatment & Management

  • Author: Crispian Scully, MD, PhD, MDS, CBE, MDS, MRCS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, DSc, DChD, DMed(HC), Dr(HC) ; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 29, 2010
 

Medical Care

The objective of care is to detect and to prevent malignant change. The presence of the white plaque alone does not require treatment.

Several management regimens have been suggested; however, no large trials have shown a definitive, reliable treatment. No evidence base exists on which to reliably recommend treatment. Indeed, current evidence suggests that no treatment is of reliable benefit.

Possible courses of action include the following:

  • Wait and watch
  • Medical therapies (eg, anti-inflammatory agents, vitamins, cytotoxic agents)[13]
  • Surgical removal (eg, scalpel, laser, cryoprobe, electrosurgery, photodynamic therapy).[14]

Patients should avoid any causal factor, such as use of tobacco and alcohol. Leukoplakias can regress under these circumstances. Any degree of dysplasia in a lesion at a high-risk site must be taken seriously and the lesion should be removed. Occasionally, patients are treated by photodynamic therapy or topical cytotoxic agents. Patients should be examined regularly, probably at 3- to 6-month intervals.

Also see the clinical guideline summary, HealthPartners Dental Group and Clinics oral cancer guideline.

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Surgical Care

Management of leukoplakias is far from satisfactory, and no large trials offer guidance as to the most reliable treatment. Surgical removal of leukoplakia seems one reasonable option. Some experts surgically remove these lesions with scalpel, laser, or cryoprobe. Laser excision is preferred to fulguration.[12, 15] Others point out the possible aggravation of dysplasia caused by such operative intervention and that surgical removal of aneuploidic lesions does not improve mortality rates.[16]

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Diet

A diet rich in fresh fruits and vegetables may help prevent cancer.

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Contributor Information and Disclosures
Author

Crispian Scully, MD, PhD, MDS, CBE, MDS, MRCS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, DSc, DChD, DMed(HC), Dr(HC)  Professor of Oral Medicine, Bristol University; Emeritus Professor of Oral Medicine and Special Care Dentistry, University College London; Professor, Oral Medicine, Pathology, and Microbiology, University of London; Visiting Professor at Universities of Athens, Bristol, Edinburgh, Granada, and Helsinki

Crispian Scully, MD, PhD, MDS, CBE, MDS, MRCS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, DSc, DChD, DMed(HC), Dr(HC) is a member of the following medical societies: Academy of Medical Science, British Society for Oral Medicine, European Association for Oral Medicine, International Academy of Oral Oncology, International Association for Dental Research, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David P Fivenson, MD  Associate Director, St Joseph Mercy Hospital Dermatology Program, Ann Arbor, Michigan

David P Fivenson, MD is a member of the following medical societies: American Academy of Dermatology, Medical Dermatology Society, Michigan Dermatological Society, Michigan State Medical Society, Photomedicine Society, Society for Investigative Dermatology, and Wound Healing Society

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Warren R Heymann, MD  Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Warnakulasuriya S, Johnson NW, van der Waal I. Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med. Nov 2007;36(10):575-80. [Medline].

  2. Bouquot JE, Weiland LH, Kurland LT. Leukoplakia and carcinoma in situ synchronously associated with invasive oral/oropharyngeal carcinoma in Rochester, Minn., 1935-1984. Oral Surg Oral Med Oral Pathol. Feb 1988;65(2):199-207. [Medline].

  3. Bagan JV, Jimenez Y, Sanchis JM, et al. Proliferative verrucous leukoplakia: high incidence of gingival squamous cell carcinoma. J Oral Pathol Med. Aug 2003;32(7):379-82. [Medline].

  4. Bagan JV, Murillo J, Poveda R, Gavalda C, Jimenez Y, Scully C. Proliferative verrucous leukoplakia: unusual locations of oral squamous cell carcinomas, and field cancerization as shown by the appearance of multiple OSCCs. Oral Oncol. Apr 2004;40(4):440-3. [Medline].

  5. Fisher MA, Bouquot JE, Shelton BJ. Assessment of risk factors for oral leukoplakia in West Virginia. Community Dent Oral Epidemiol. Feb 2005;33(1):45-52. [Medline].

  6. El-Wajeh YA, Thornhill MH. Qat and its health effects. Br Dent J. Jan 10 2009;206(1):17-21. [Medline].

  7. [Best Evidence] Thomas SJ, Harris R, Ness AR, Taulo J, Maclennan R, Howes N, et al. Betel quid not containing tobacco and oral leukoplakia: a report on a cross-sectional study in Papua New Guinea and a meta-analysis of current evidence. Int J Cancer. Oct 2008;123(8):1871-6.

  8. Allen CL, Loudon J, Mascarenhas AK. Sanguinaria-related leukoplakia: epidemiologic and clinicopathologic features of a recently described entity. Gen Dent. Nov-Dec 2001;49(6):608-14. [Medline].

  9. Eversole LR, Eversole GM, Kopcik J. Sanguinaria-associated oral leukoplakia: comparison with other benign and dysplastic leukoplakic lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Apr 2000;89(4):455-64. [Medline].

  10. Jiang WW, Fujii H, Shirai T, Mega H, Takagi M. Accumulative increase of loss of heterozygosity from leukoplakia to foci of early cancerization in leukoplakia of the oral cavity. Cancer. Nov 1 2001;92(9):2349-56. [Medline].

  11. Holmstrup P, Vedtofte P, Reibel J, Stoltze K. Oral premalignant lesions: is a biopsy reliable?. J Oral Pathol Med. May 2007;36(5):262-6. [Medline].

  12. Chiesa F, Tradati N, Sala L, et al. Follow-up of oral leukoplakia after carbon dioxide laser surgery. Arch Otolaryngol Head Neck Surg. Feb 1990;116(2):177-80. [Medline].

  13. Garewal HS, Katz RV, Meyskens F, et al. Beta-carotene produces sustained remissions in patients with oral leukoplakia: results of a multicenter prospective trial. Arch Otolaryngol Head Neck Surg. Dec 1999;125(12):1305-10. [Medline].

  14. [Best Evidence] Brennan M, Migliorati CA, Lockhart PB, Wray D, Al-Hashimi I, Axell T. Management of oral epithelial dysplasia: a review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Mar 2007;103 Suppl:S19.e1-12. [Medline].

  15. Chiesa F, Sala L, Costa L, et al. Excision of oral leukoplakias by CO2 laser on an out-patient basis: a useful procedure for prevention and early detection of oral carcinomas. Tumori. Jun 30 1986;72(3):307-12. [Medline].

  16. Sudbo J, Lippman SM, Lee JJ, et al. The influence of resection and aneuploidy on mortality in oral leukoplakia. N Engl J Med. Apr 1 2004;350(14):1405-13. [Medline].

  17. Sudbo J, Kildal W, Risberg B, Koppang HS, Danielsen HE, Reith A. DNA content as a prognostic marker in patients with oral leukoplakia. N Engl J Med. Apr 26 2001;344(17):1270-8. [Medline].

  18. Abdel-Salam M, Mayall BH, Chew K, Silverman S Jr, Greenspan JS. Prediction of malignant transformation in oral epithelial lesions by image cytometry. Cancer. Nov 1 1988;62(9):1981-7. [Medline].

  19. Banoczy J. Follow-up studies in oral leukoplakia. J Maxillofac Surg. Feb 1977;5(1):69-75. [Medline].

  20. Bouquot JE, Whitaker SB. Oral leukoplakia--rationale for diagnosis and prognosis of its clinical subtypes or "phases". Quintessence Int. Feb 1994;25(2):133-40. [Medline].

  21. Ikeda N, Ishii T, Iida S, Kawai T. Epidemiological study of oral leukoplakia based on mass screening for oral mucosal diseases in a selected Japanese population. Community Dent Oral Epidemiol. Jun 1991;19(3):160-3. [Medline].

  22. Jaber MA, Porter SR, Speight P, Eveson JW, Scully C. Oral epithelial dysplasia: clinical characteristics of western European residents. Oral Oncol. Sep 2003;39(6):589-96. [Medline].

  23. Kramer IR, Lucas RB, Pindborg JJ, Sobin LH. Definition of leukoplakia and related lesions: an aid to studies on oral precancer. Oral Surg Oral Med Oral Pathol. Oct 1978;46(4):518-39. [Medline].

  24. Kulasegaram R, Downer MC, Jullien JA, Zakrzewska JM, Speight PM. Case-control study of oral dysplasia and risk habits among patients of a dental hospital. Eur J Cancer B Oral Oncol. Jul 1995;31B(4):227-31. [Medline].

  25. Lumerman H, Freedman P, Kerpel S. Oral epithelial dysplasia and the development of invasive squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Mar 1995;79(3):321-9. [Medline].

  26. Marley JJ, Linden GJ, Cowan CG, et al. A comparison of the management of potentially malignant oral mucosal lesions by oral medicine practitioners and oral & maxillofacial surgeons in the UK. J Oral Pathol Med. Nov 1998;27(10):489-95. [Medline].

  27. McCarthy FP. Etiology, pathology and treatment of leukoplakia buccalis with a report of 316 cases. Arch Dermatol Syph. 1936;6:612-23.

  28. Pentenero M, Carrozzo M, Pagano M, et al. Oral mucosal dysplastic lesions and early squamous cell carcinomas: underdiagnosis from incisional biopsy. Oral Dis. Mar 2003;9(2):68-72. [Medline].

  29. Sankaranarayanan R, Nair MK, Mathew B, Balaram P, Sebastian P, Dutt SC. Recent results of oral cancer research in Kerala, India. Head Neck. Mar-Apr 1992;14(2):107-12. [Medline].

  30. Schepman K, der Meij E, Smeele L, der Waal I. Concomitant leukoplakia in patients with oral squamous cell carcinoma. Oral Dis. Jul 1999;5(3):206-9. [Medline].

  31. Schepman KP, van der Waal I. A proposal for a classification and staging system for oral leukoplakia: a preliminary study. Eur J Cancer B Oral Oncol. Nov 1995;31B(6):396-8. [Medline].

  32. Sciubba JJ. Oral leukoplakia. Crit Rev Oral Biol Med. 1995;6(2):147-60. [Medline].

  33. Scully C, Cawson RA. Potentially malignant oral lesions. J Epidemiol Biostat. 1996;1:3-12.

  34. Scully C, Sudbo J, Speight PM. Progress in determining the malignant potential of oral lesions. J Oral Pathol Med. May 2003;32(5):251-6. [Medline].

  35. Silverman S Jr, Gorsky M, Lozada F. Oral leukoplakia and malignant transformation. A follow-up study of 257 patients. Cancer. Feb 1 1984;53(3):563-8. [Medline].

  36. [Best Evidence] Smith J, Rattay T, McConkey C, Helliwell T, Mehanna H. Biomarkers in dysplasia of the oral cavity: a systematic review. Oral Oncol. Aug 2009;45(8):647-53. [Medline].

  37. Szpirglas H. [Detection of oral cancers and current conception of precancerous conditions]. Rev Prat. Apr 1 1995;45(7):831-7. [Medline].

  38. van der Waal RI, Pas HH, Nousari HC, et al. Paraneoplastic pemphigus caused by an epithelioid leiomyosarcoma and associated with fatal respiratory failure. Oral Oncol. Jul 2000;36(4):390-3. [Medline].

  39. Waldron CA, Shafer WG. Leukoplakia revisited. A clinicopathologic study 3256 oral leukoplakias. Cancer. Oct 1975;36(4):1386-92. [Medline].

  40. Wright JM. Oral precancerous lesions and conditions. Semin Dermatol. Jun 1994;13(2):125-31. [Medline].

  41. Zavras AI, Laskaris C, Kittas C, Laskaris G. Leukoplakia and intraoral malignancies: female cases increase in Greece. J Eur Acad Dermatol Venereol. Jan 2003;17(1):25-7. [Medline].

 
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Homogeneous leukoplakia.
Erythroleukoplakia.
Verrucous or nodular leukoplakia.
Carcinoma referred to as a leukoplakia.
 
 
 
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