Laboratory Studies

Although no definitive role has been identified for human papillomavirus (HPV) infection, lesional polymerase chain reaction testing for HPV DNA may be performed. In addition, flow cytometric analysis of tissue may have a role in detecting lesions of proliferative verrucous leukoplakia (PVL) early in the course of disease. Furthermore, increased expression of Mcm-2 as detected by immunohistochemistry may be helpful in identifying areas of potential malignant transformation within lesions of proliferative verrucous leukoplakia.^{[24, 25]}A small 2016 study of salivary proteins has shown an association with low-expression levels of angiotensin and dipeptidyl peptidase 1 proteins in proliferative verrucous leukoplakia patients versus controls, suggesting that these could be used as potential biomarkers of disease in the future.^[26]

Procedures

Perform an oral biopsy using either a scalpel or a brush biopsy, and use computer-aided analytical techniques to detect dysplasia or carcinoma.

Histologic Findings

Histology findings can range from verrucous hyperplasia to verrucous carcinoma to less-differentiated carcinoma and can include any combination of these histologic features. Additionally, a lymphocytic lichenoid infiltrate without evidence of significant basilar vacuolization has been reported in some cases.^{[10, 20]}One or more of these histologic features may appear in a single biopsy specimen, multiple biopsies taken at the same time, or from serial biopsies over time.^[27]Because of this variability, the diagnosis of proliferative verrucous leukoplakia (PVL) is based mainly on clinical findings.^{[28, 29]}

Treatment & Management

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Media Gallery

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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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, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Fatima A Abdulla, MD Associated Staff Physician, Department of Dermatology, Cleveland Clinic Abu Dhabi, UAE

Fatima A Abdulla, MD is a member of the following medical societies: European Academy of Dermatology and Venereology, Jordan Medical Association, Jordanian Society of Dermatology and Venereology

Disclosure: Nothing to disclose.

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, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman 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, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

Jeff Burgess, DDS, MSD (Retired) Clinical Assistant Professor, Department of Oral Medicine, University of Washington School of Dental Medicine; (Retired) Attending in Pain Center, University of Washington Medical Center; (Retired) Private Practice in Hawaii and Washington; Director, Oral Care Research Associates

Disclosure: Nothing to disclose.

Additional Contributors

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: Received consulting fee from Orfagen for consulting; Received consulting fee from Maruho for consulting; Received consulting fee from Astellas for consulting; Received consulting fee from Abbott for consulting; Received consulting fee from Leo Pharma for consulting; Received consulting fee from Biogenoma for consulting; Received honoraria from Janssen for speaking and teaching; Received honoraria from Medac for speaking and teaching; Received consulting fee from Dignity Sciences for consulting; .