Ol is premalignant and is associated with squamous cell carcinoma scc. Leukoplakia has various appearances and changes can usually develop on the gums, the inside of cheeks, and the bottom of the mouth as well as often on the tongue and can also appear as. Proliferative verrucous leukoplakia and its progression to. Proliferative verrucous leukoplakia is a multifocal and progressive lesion of. Proliferative verrucous leukoplakia pvl is a rare type of oral leukoplakia, where white patches that have a high risk of becoming cancerous develop inside the mouth. Proliferative verrucous leukoplakia diagnostic pitfalls and. Proliferative verrucous leukoplakia pvl and verrucous hyperplasia vh are two interrelated oral mucosal lesions.
Recognition and differentiation from conventional leukoplakia and mimics. The treatment with the photodynamic therapy of these lesions represents, in the last years, an innovative. It starts as a slowgrowing, persistent, multifocal lesion. The development of proliferative verrucous leukoplakia in. Oct 10, 2011 in this letter i propose the name proliferative multifocal leukoplakia with the goal of reducing underdiagnosis of this disease, improve the early diagnosis, try to make an early therapy and control, and prevent its malignant transformation. Pvl behaves in a more aggressive and relentless manner than the more innocuous white oral lesions that it can. We hereby present a case report, where we have used diode laser for surgical management of a proliferative verrucous leukoplakia pvl, because of its many. Proliferative verrucous leukoplakia pvl is a rare form of oral leukoplakia, which was first described in 1985 by hansen et al. Objectiveproliferative verrucous leukoplakia pvl is a rare and. Schmalbach md, facs1 1department of otolaryngology head and neck surgery, wilford hall medical center, lackland afb, texas. This is a disorder which is most generally found in the elderly. The term proliferative verrucous leukoplakia pvl has been defined by hansen et al. Even after leukoplakia patches are removed, the risk of oral cancer remains. Proliferative verrucous leukoplakia is seen mainly in older women, beginning as a simple slowgrowing, persistent leukoplakia that tends to spread and become multifocal and affect the gingival frequently.
Malignant transformation of proliferative verrucous leukoplakia to. Hairy leukoplakia creates fuzzy, white patches that can be mistaken for oral thrush. Jun 18, 2014 about 60% of the oral cancer arise on a preexistent potentially malignant disorder of oral mucosa like the oral proliferative verrucous leukoplakia. Leukoplakia usually doesnt cause permanent damage to tissues in your mouth. Was to describe 14 cases of a proliferative verrucous leukoplakia as a clinical evolution of oral lichen planus. Optimal management of proliferative verrucous leukoplakia. It is a form of leukoplakia, which refers to white patches on the mucous membranes of the mouth often arising in response to chronic irritation. Proliferative verrucous leukoplakia a clinico pathological entity.
Since then, various published case series have presented pvl as a. Image exophytic leukoplakia on the buccal mucosa 11. Nov 10, 2016 leukoplakia of the anterior floor of the mouth and undersurface of the tongue is strongly associated with malignant potential. Proliferative verrucous leukoplakia pvl is a recognized high risk subtype of non homogenous leukoplakia. Proliferative verrucous leukoplakia pvl is a distinct clinical form of oral leukoplakia defined by its progressive clinical course, changing clinical and histopathological features, and potential to develop into cancer. Underdiagnosed oral precursor lesion that requires retrospective clinicopathological correlation ozgur mete 1, yaren keskin 2, gunter hafiz 3, kivanc bektas kayhan 2, meral unur 2 dermatology online journal 16 5. Leukoplakia is a firmly attached white patch on a mucous membrane which is associated with. Oral leukoplakia ol is a white patch or plaque of the oral mucosa that cannot be characterised clinically or pathologically as any other condition such as cheek biting, candidosis, lichen planus and materia alba. Since then, various published case series have presented pvl as a disease with aggressive biological behavior due to its high probability of recurrence and a high rate of malignant transformation, usually higher than 70%.
Leukoplakia causes, pictures, symptoms, treatment, prognosis. Oral leukoplakia and proliferative verrucous leukoplakia. This article looks at leukoplakia of the head and neck. Examination early in the disease process may reveal isolated areas of leukokeratosis, sometimes with adjacent erythematous mucosa, as demonstrated in the image below. Proliferative verrucous leukoplakia is a malignant form of leukoplakia of unknown etiology and is thought to be associated with human papilloma virus hpv. Oral leukoplakia describes a white patch or plaque of the oral mucosa that cannot be characterised clinically or pathologically as any other disease. Leukoplakia is a relatively common clinical finding in clinical medicine. Carcinoma in situ of the oral cavity i ntraepithelial carcinoma. It mainly involves the lining inside of the cheeks buccal mucosa and tongue. B pvl in the buccal mucosa with different clinical patterns. Proliferative verrucous leukoplakia pvl is a rare form of oral. Oral proliferative verrucous leukoplakia treated with the.
Proliferative verrucous leukoplakia pvl is of uncertain etiology but may be associated with human papillomavirus hpv infection. Epidemiological and clinicopathological study of oral leukoplakia. Proliferative verrucous leukoplakia pvl is rare high risk form of leukoplakia first described by hansen and. Proliferative verrucous leukoplakia of the gingiva. Pdf download for optimal management of proliferative verrucous. Feb 20, 2019 proliferative verrucous leukoplakia pvl is an uncommon form of progressive multifocal leukoplakia with a high rate of malignant transformation to either squamous cell cancer or verrucous carcinoma and a high probability of recurrence. Hairy leukoplakia is a result of infections stemming from the epsteinbarr virus ebv, which remains in the body for your lifetime. After this study, these lesions were named oral proliferative verrucous leukoplakia opvl. Kanmani2, n megalai3 1department of oral medicine and radiology, indira gandhi institute of dental sciences, pondicherry, india, 2department of oral medicine and radiology, srm. The clinical and histopathological characteristics of 14 cases of olp that progress towards a plaquelike and verrucous form were indicated, with monitoring over a period of six to 24. Proliferative verrucous leukoplakia pvl is a very aggressive and rare form of oral leukoplakia ol with high morbidity. Among them oral leukoplakia ol is quite prevalent 0. This function is accomplished through a ligation between betacarotene and oxygen, which is an unstable reactive molecule, thus diminishing the damaging effects of free radicals lycopene in vitro experiments have shown the inhibition of the process of human neoplastic cellular growth by lycopene, since this. Feb 20, 2019 proliferative verrucous leukoplakia pvl lesions commonly occur on the buccal mucosa, gingiva, tongue, floor of the mouth, and palate.
Proliferative verrucous leukoplakia diagnostic pitfalls and suggestions kundendu a. Proliferative verrucous leukoplakia and its related lesions. 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. Pdf proliferative verrucous leukoplakia victor lopes.
Diagnostic criteria in proliferative verrucous leukoplakia. Oral cancers often form near leukoplakia patches, and the patches themselves may show cancerous changes. An aggressive form of oral leukoplakia thomas p shopper, robert b brannon and william h stalker thomas p. It starts as a white plaque of thickened skin hyperkeratosis that eventually spreads and forms rough, wartlike verrucous lesions that may look. Hairy leukoplakia is a condition that is characterised by irregular white patches on the side of the tongue and occasionally elsewhere on the tongue or in the mouth. Proliferative verrucous leukoplakia proliferative verrucous leukoplakia pvl is a recognized high risk subtype of nonhomogenous leukoplakia. However, this report described a case of rapid progress, which had malignant. Proliferative verrucous leukoplakia is a rare and distinct variant of oral leukoplakia. Oral proliferative verrucous leukoplakia revisited introduction after its introduction in 1985 by hansen et al. However, leukoplakia is not limited as an oral disorder alone, as it may also appear in the genital area of the female. Proliferative verrucous leukoplakia a clinico pathological. It involves multiple mucosal areas with confuent, exophytic and proliferative features.
Oral leukoplakia may later prove to be due to one of the following conditions. Leukoplakia could be classified as mucosal disease, and also as a premalignant condition. Leukoplakia is a condition wherein white or gray patches appear in some parts of the mouth, predominantly in the buccal mucosa and the tongue. An update keerthi muddana1, deepsagar thadudari2, aruna kumari maloth3, gouri pupala4, nandan srk5 abstract. Proliferative verrucous oral leukoplakia is a subtype of verrucous leukoplakia according to some authors3,6. Proliferative multifocal leukoplakia better name that. One study found that men over the age of 60 with oral leukoplakia on the lateral or ventral aspect of the tongue, who had a nonhomogenous lesion with highgrade dysplasia, were most at risk of malignant change. However, leukoplakia increases your risk of oral cancer. Grayish or white patches which can not be wiped away.
The diagnosis can only be achieved through the keen clinical observation of the temporal progression in individual patients to verrucous andor conventional squamous carcinoma. This report describes a case of proliferative verrucous leukoplakia pvl of the. There is another form called hairy leukoplakia that, like oral thrush, affects those with weakened immune systems more adversely. The typical benign leukoplakia is also dealt with separately. May 19, 2017 the surface texture is irregular compared to homogenous leukoplakia, and may be flat papular, nodular or exophytic.
Proliferative verrucous leukoplakia clinical presentation. The diagnosis of this entity is predicated on a temporal constellation of clinical features and histopathologic findings. Nov 06, 2017 proliferative verrucous leukoplakia pvl is a rare type of oral leukoplakia, where white patches that have a high risk of becoming cancerous develop inside the mouth. In treatment of recurrent verrucous leukoplakia ncbi. Department of head and neck surgery, the university of texas md anderson cancer center, houston, texas. About 60% of the oral cancer arise on a preexistent potentially malignant disorder of oral mucosa like the oral proliferative verrucous leukoplakia. It should be acknowledged that some lesions may initially be pinkish or even red rather than white. Proliferative verrucous leukoplakia genetic and rare. Patients with idiopathic leukoplakia have the highest risk of developing cancer. Proliferative verrucous leukoplakia pvl is a rare, unique type of oral leukoplakia, which is enigmatic in etiology and behaves in a far more aggressive fashion than other forms of leukoplakia.
Although the white color in leukoplakia is a result of hyperkeratosis or acanthosis, similarly appearing white lesions that are caused by reactive keratosis smokers keratosis or frictional keratoses e. Bishen 1, amit sethi 2 1 mds, assistant professor, oral and maxillofacial pathology, manipal college of dental sciences, mangalore 2 mds, mfds, assistant professor, oral and maxillofacial surgery, manipal college of dental sciences, manipal correspondence. Case report of rapidly progressive proliferative verrucous. As mentioned above, most pvl cases processed to malignancy over many years, sometimes 20 years. Proliferative verrucous leukoplakia pvl is a rare form of oral leukoplakia, with high recurrent rates and a high risk of malignant. A proliferative verrucous leukoplakia pvl in the lower attached gingival, vestibular sulcus and gradually extended along left alveolar ridge. Proliferative verrucous leukoplakia pvl is considered to be a progressive type of oral leukoplakia that is impossible to recognize in its nascent stages. Chronic hyperplastic candidosiscandidiasis candidal leukoplakia pdf. This is largely due to the overlapping clinical and pathologic early features with conventional multifocal leukoplakia with dysplasia.
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