Oral leukoplakia and proliferative verrucous leukoplakia: a review for dental practitioners

Key Points

  • Provides an update on oral leukoplakia and proliferative verrucous leukoplakia.

  • Highlights the importance of early recognition and diagnosis of these lesions.

  • Provides an overview of the current investigations and management options.

Abstract

Objectives To provide an overview of the current thinking in terms of the diagnosis and management of oral leukoplakia and proliferative verrucous leukoplakia as relevant to general dental practitioners.

Data sources, data selection, data extraction, data synthesis We searched the MEDLINE Ovid, EMBASE databases and the Cochrane Library, (1990 to 16 April 2017), restricting our search to English language with the following key words: leukoplakia, white patch, proliferative verrucous leukoplakia, precancerous lesion, premalignant lesions, potentially malignant oral conditions and potentially malignant oral disorders. The two authors selected key papers and engaged in collaborative data extraction and synthesis of the selected reference material.

Conclusions General dental practitioners (GDPs) are likely to encounter patients with a known or yet undiagnosed oral leukoplakia in their clinical practice. The diagnosis is clinically based as there are no pathognomonic histopathological features. The definition of leukoplakia has evolved over the years. The importance of recognition and appropriate management relating to this condition is described particularly as it is one of the oral potentially malignant lesions. The inferred increased risk of malignant transformation is well documented however controversy still persists in terms of the appropriate management for these lesions. Proliferative verrucous leukoplakia is a recalcitrant, often widespread and multifocal distinct type of leukoplakia. It is considered to have a high rate of malignant transformation with implications in terms of lifelong monitoring both clinically and histopathologically. A high index of suspicion is important for general dental practitioners in order to identify such lesions that would require onward referral for further investigation and management.

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Figure 6: Proliferative verrucous leukoplakia with a widespread involvement of the maxillary gingivae.

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Staines, K., Rogers, H. Oral leukoplakia and proliferative verrucous leukoplakia: a review for dental practitioners. Br Dent J 223, 655–661 (2017). https://doi.org/10.1038/sj.bdj.2017.881

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