Proliferative Verrucous Leukoplakia Treatment & Management

  • Author: Rahat S Azfar, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 19, 2012
 

Medical Care

Owing to the progressive nature of proliferative verrucous leukoplakia (PVL), many forms of therapy used for the management of traditional leukoplakia have been disappointing. Carbon dioxide laser, radiation, topical bleomycin solution, oral retinoids, beta-carotene, and systemic chemotherapy have all failed at achieving permanent cure. Although improvements have been noted with some of these modalities, recurrence rates after cessation of therapy are high, often within months of discontinuation of treatment.

Laser ablation reportedly has been successful in a very small group of patients followed for 6-178 months.[26] Topical photodynamic therapy also may prove useful; it causes relatively low morbidity and no scarring, and multiple mucosal sites can be treated simultaneously. However, multiple treatments over the course of the disease's progression may be required.

Methisoprinol (isoprinosine or inosine pranobex) is a synthetic agent capable of inhibiting viral RNA synthesis and replication and of stimulating antiviral cell–mediated reactions that has been shown to have some clinical efficacy in HPV-induced lesions. In an open-label trial of HPV-positive patients with proliferative verrucous leukoplakia treated with surgery alone versus surgery with presurgical and postsurgical treatment with methisoprinol at 500 mg q4h for 3 days preoperatively, followed by 500 mg bid for 2 months postoperatively, 72% and 16% of patients in each respective treatment arm experienced relapse at 18-month postoperative follow-up; however, no longer-term follow-up or randomized controlled trial data are available.[27]

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Surgical Care

Surgical resection is the current treatment of choice for proliferative verrucous leukoplakia. However, given the high rate of recurrence, multiple surgical interventions may be necessary, including block resections in cases involving the gingiva.[24]

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Consultations

Consultations with an oromaxillary pathologist, oral surgeon, and otorhinolaryngologist are suggested.

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Contributor Information and Disclosures
Author

Rahat S Azfar, MD  Clinical Instructor, Department of Dermatology, University of Pennsylvania Health System

Rahat S Azfar, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Specialty Editor Board

Jacek C Szepietowski, MD, PhD  Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Stiefel GSK Company Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting; Abbott Consulting fee Consulting; Leo Pharma Consulting fee Consulting

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

References

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  2. Bagan JV, Jimenez Y, Murillo J, et al. Lack of association between proliferative verrucous leukoplakia and human papillomavirus infection. J Oral Maxillofac Surg. Jan 2007;65(1):46-9. [Medline].

  3. Campisi G, Giovannelli L, Ammatuna P, et al. Proliferative verrucous vs conventional leukoplakia: no significantly increased risk of HPV infection. Oral Oncol. Sep 2004;40(8):835-40. [Medline].

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A leukokeratotic plaque is seen in on the upper lip, along with an erythematous plaque on the left hard palate. The patient has a large right-palate defect from a prior surgical excision of a squamous cell carcinoma.
 
 
 
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