Diagnosis and Management of Leukoplakia and Premalignant Lesions

Abstract

Summary The risk for malignant transformation in oral leukoplakia is always present. Because leukoplakia and carcinoma can occur simultaneously and an established prognostic clinical guide is lacking, all-white lesions characterized as leukoplakia must be diagnosed microscopically and either removed or monitored with care. Biopsy is the only definitive way to establish the exact nature of oral leukoplakias. When seeking dysplastic or malignant areas in leukoplakic lesions, it is important to remember that erythematous and speckled regions are more likely to be dysplastic or cancerous than thick and homogeneous white regions. It also must be remembered that the diagnosis of a previously biopsied benign white patch must be reaffirmed periodically because a leukoplakia may transform unpredictably into malignancy. Moreover, although a leukoplakic lesion may regress and disappear when an irritant is reduced or removed, it can recur and subsequently may become cancerous. In determining the aggressiveness of treatment, consideration of potential risk factors is essential. These factors are (1) an erythematous component or red lesion, (2) microscopic dysplasia, (3) a clinical appearance of PVL, (4) associated candidiasis observed microscopically, (5) a nonsmoking patient, and (6) pain or irritation (leukoplakia is usually asymptomatic).