Abstract
Proliferative verrucous leukoplakia (PVL) is a chronic, aggressive oral mucosal condition with a poor long-term prognosis. It has no specific, defining microscopic characteristics and is a clinical rather than histological diagnosis. PVL may appear clinicopathologically innocuous in its early stages, but there are clues that can alert the histopathologist to a dangerous condition, such as the recognition of hyperkeratoses which, though apparently benign, are inconsistent with well-defined reactive entities. The intermediate stages may show a constellation of histological appearances, and although terminology remains unsatisfactory verrucous hyperplasia, verrucous carcinoma and papillary squamous cell carcinoma are diagnoses which have stood the test of time. The temptation to use unconventional, individual and subjective terms which are descriptions rather than diagnoses should be resisted where possible. The aim of this article is to review the histopathology of PVL, describe its early microscopic indicators and discuss differential diagnoses.
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