Proliferative Verrucous Leukoplakia Treatment & Management

Updated: Feb 20, 2019
  • Author: Rahat S Azfar, MD; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Treatment

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. Topical imiquimod therapy has been suggested to be successful. [30]

Laser ablation reportedly has been successful in a very small group of patients followed for 6-178 months. [31] Diode laser based excision has been reported to achieve a good clinical response over a 2-year period in one case report of HPV-16–associated proliferative verrucous leukoplakia. [32]

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. [33]

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Surgical Care

Surgical resection is the current treatment of choice for proliferative verrucous leukoplakia (PVL). However, given the high rate of recurrence, multiple surgical interventions may be necessary, including block resections in cases involving the gingiva. [28]

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Consultations

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

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Prevention

Advise patients with proliferative verrucous leukoplakia (PVL) to avoid other known factors associated with development of oral carcinoma, such as tobacco, alcohol, and betel.

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Long-Term Monitoring

Given the high rate of malignant transformation in patients with proliferative verrucous leukoplakia (PVL), a thorough intraoral examination should be performed every 6 months, with a low threshold for biopsy of suggestive lesions.

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