Dermatologic Manifestations of Oral Leukoplakia Treatment & Management

Updated: Apr 17, 2017
  • Author: James J Sciubba, DMD, PhD; Chief Editor: William D James, MD  more...
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Treatment

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:

  • Remove any precipitating factors

  • Medical therapies (eg, anti-inflammatory agents, vitamins, cytotoxic agents) [29]

  • Surgical removal (eg, scalpel, laser, cryoprobe, electrosurgery, photodynamic therapy). [30]

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. Given that even evidently nondysplastic lesions may still contain malignancy in up to 10%, surgical removal of the lesion is advocated. Occasionally, patients are treated by photodynamic therapy or topical cytotoxic agents, but the evidence for efficacy is slender. Patients should be examined regularly, probably at 3- to 6-month intervals.

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Surgical Care

Management of leukoplakias is far from satisfactory, [31] 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. [24, 32] Others point out the possible aggravation of dysplasia caused by such operative intervention and that surgical removal of aneuploidic lesions does not necessarily improve mortality rates. [33]

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Diet

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

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Prevention

Counsel patients against tobacco use. The percentage of nonsmokers who develop malignancy in a leukoplakia is greater than the percentage of smokers who develop a malignancy in a leukoplakia; however, the condition is more common in smokers such that the overall number of malignancies that arise in leukoplakias is greater in smokers.

Advise patients to avoid alcohol use. Additionally, advise patients to eat a diet high in fresh fruits and vegetables.

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Long-Term Monitoring

Examine patients with leukoplakias regularly at 3- to 6-month intervals. Detection of clinical changes, such as erosions or nodule formation, warrants a biopsy. An oral brush biopsy may be helpful in detecting dysplasia.

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