Abstract
BackgroundProliferative verrucous leukoplakia (PVL) is an oral potentially malignant disorder, characterized by multifocal expression, progressive clinical evolution, and a high rate of malignant transformation. Evidence-based information regarding optimal PVL management is lacking, due to the paucity of data. The present report describes a case of PVL associated with HPV-16 infection and epithelial dysplasia treated by diode laser surgery, and the outcome of disease clinical remission over a 2-year follow-up period.Case reportA 61-year-old Caucasian male with oral verrucous hyperkeratosis presented for diagnosis. The lesions were localized on the maxillary gingiva and palatal alveolar ridge. Multiple biopsy specimens have been taken by mapping the keratotic lesion area. Microscopic examination was compatible with a diagnosis of PVL with focal mild dysplasia, localized in the right maxillary gingiva. Polymerase chain reaction (PCR) was done for human papillomavirus (HPV) detection which revealed presence of HPV DNA, and the genotype revealed HPV 16 in the sample. The PVL in the right gingival area was treated on an outpatient basis by excision with a diode laser. This approach resulted in good clinical response and decreased morbidity over a 2-year follow-up period.ConclusionsThis case illustrates the benefit of a conservative approach by diode laser treatment than wide surgical excision for management of the PVL lesions associated with mild dysplasia and HPV-16 infection.
Highlights
Proliferative verrucous leukoplakia (PVL) is an oral potentially malignant disorder, characterized by multifocal expression, progressive clinical evolution, and a high rate of malignant transformation
This case illustrates the benefit of a conservative approach by diode laser treatment than wide surgical excision for management of the PVL lesions associated with mild dysplasia and human papillomavirus (HPV)-16 infection
The presence of HPV-16 infection associated with epithelial dysplasia can justify—as the present case—the wide surgical excision of the affected site, trying to minimize the operational invasiveness
Summary
No specific treatment modality has proven to be effective in the management of the PVL, either to slow down its progression toward malignant transformation and limit the high frequency of recurrence [2, 14]. The conventional treatment of PVL is surgical excision, complete removal of the lesions may be challenging because of the multifocal manifestation of the oral lesions [14]. This approach can lead to significant morbidity and compromised quality of life. Recurrence and progression are very common in the PVL lesions, whether the microscopic evaluation of the tissue sample confirms the HPV infection associated with mild dysplasia, the laser excision can be considered as surgical option. Author details 1Maxillo-Facial and Dental Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan, Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Via Della Commenda 10, 20122 Milan, Italy.
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