Schmalbach md, facs1 1department of otolaryngology head and neck surgery, wilford hall medical center, lackland afb, texas. Grayish or white patches which can not be wiped away. Proliferative verrucous leukoplakia pvl is a rare form of oral. Oral leukoplakia may later prove to be due to one of the following conditions.
Proliferative verrucous leukoplakia diagnostic pitfalls and. It is characterized by a high rate of oral squamous cell carcinoma and verrucou carcinoma transformations. 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. Oral lichen planus, proliferative verrucous oral leukoplakia, malignant oral lichen planus, multifocal verrucous oral lichen planus, proliferative verrucous oral lichen planus.
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. May 10, 2019 leukoplakia is a condition in which thick, white or grayish patches form usually inside your mouth. Each has been shown to have a considerable propensity to progress to carcinomaeither verrucous or conventional squamous cell carcinoma of varying degrees of differentiation. 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. Was to describe 14 cases of a proliferative verrucous leukoplakia as a clinical evolution of oral lichen planus. 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. It mainly involves the lining inside of the cheeks buccal mucosa and tongue. Proliferative verrucous leukoplakia pvl is a rare form of oral leukoplakia, with high recurrent rates and a high risk of malignant. 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. A white patch in your mouth that does not go away should be checked by a dentist or gp. Leukoplakia appears as thick, white patches on the inside surfaces of your mouth.
In treatment of recurrent verrucous leukoplakia ncbi. The health professional can usually identify them by patient history and clinical xamination. Oral leukoplakia and proliferative verrucous leukoplakia. 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. Among them oral leukoplakia ol is quite prevalent 0. Pdf proliferative verrucous leukoplakia a recalcitrant. The development of proliferative verrucous leukoplakia in. 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. Proliferative verrucous leukoplakia pvl is a particularly aggressive form of oral leukoplakia which is characterized by multifocal and recurrent lesions which are typically exophytic with a verruciform or papillary surface pattern hansen et al. Proliferative verrucous leukoplakia pvl is rare high risk form of leukoplakia first described by hansen and.
Proliferative verrucous leukoplakia pvl is an oral potentially malignant disorder, characterized by multifocal expression, progressive clinical. Pdf proliferative verrucous leukoplakia victor lopes. White lesions such as linea alba, leukoedema, and frictional keratosis are common in the oral cavity but have no propensity for malignant transformation. Case report an unusual case report of an early proliferative. Proliferative verrucous leukoplakia a clinico pathological entity. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Proliferative verrucous leukoplakia pvl is a rare potentially malignant lesion of oral mucous that firstly described by hansen et al in 1985. The treatment with the photodynamic therapy of these lesions represents, in the last years, an innovative. Proliferative verrucous leukoplakia pvl is a distinct form of oral leukoplakia characterized by a high recurrence rate and high.
This is a disorder which is most generally found in the elderly. 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. Oral leukoplakia describes a white patch or plaque of the oral mucosa that cannot be characterised clinically or pathologically as any other disease. 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. 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.
Carcinoma in situ of the oral cavity intraepithelial carcinoma nicotine stomatitis. Proliferative verrucous leukoplakia pvl is an aggressive, recalcitrant form of leukoplakia requiring special clinical attention due to the high. Oral proliferative verrucous leukoplakia treated with the. Proliferative verrucous leukoplakia differential diagnoses. Shopper, dds, med, is an associate pr ofessor in the department of or al diagnosis, oral medicine, and radiology. A rare, recalcitrant, and lethal form of leukoplakia necessitate special attention. Interobserver variability in the diagnosis of proliferative verrucous. Malignant transformation of proliferative verrucous leukoplakia to. The diagnosis can only be achieved through the keen clinical observation of the temporal progression in individual patients to verrucous andor conventional squamous carcinoma. N2 proliferative verrucous leukoplakia pvl is a particularly aggressive form of oral leukoplakia that is resistant to treatment and presents a high risk of recurrence and malignant transformation.
The term proliferative verrucous leukoplakia pvl has been defined by hansen et al. As mentioned above, most pvl cases processed to malignancy over many years, sometimes 20 years. Proliferative verrucous leukoplakia is a subtype of non homogeneous, verrucous leukoplakia24,25. Oral leukoplakia amsterdam umc vrije universiteit amsterdam. 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. Proliferative verrucous leukoplakiapvl is rare high risk form of leukoplakia first described by hansen and. Proliferative verrucous leukoplakia pvl and verrucous hyperplasia vh are two interrelated oral mucosal lesions. Proliferative verrucous leukoplakia is a multifocal and progressive lesion of the oral mucosa, with unknown etiology, and commonly resistant to all therapy attempts with frequent recurrences. Proliferative verrucous leukoplakia and its related lesions. However, leukoplakia is not limited as an oral disorder alone, as it may also appear in the genital area of the female. Carcinoma, proliferative verrucous leukoplakia and ebv epsteinbarr virus in oral proliferative verrucous leukoplakia and squamous cell carcinoma. The diagnosis of this entity is predicated on a temporal constellation of clinical features and histopathologic findings.
Kanmani2, n megalai3 1department of oral medicine and radiology, indira gandhi institute of dental sciences, pondicherry, india, 2department of oral medicine and radiology, srm. 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. However, this report described a case of rapid progress, which had malignant. 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. After this study, these lesions were named oral proliferative verrucous leukoplakia opvl. Carcinoma, proliferative verrucous leukoplakia and ebv med oral patol oral cir bucal. Oct 10, 2011 therefore, if you consider the verrucous appearance as a major criterion, the diagnosis of this disease may happen to be delayed. Proliferative verrucous leukoplakia pvl is of uncertain etiology but may be associated with human papillomavirus hpv infection. 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. 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. Case report of rapidly progressive proliferative verrucous. It can also be a sign of precancerous changes in the mouth or mouth cancer. Proliferative verrucous leukoplakia pvl is considered to be a progressive type of oral leukoplakia that is impossible to recognize in its nascent stages.
It should be acknowledged that some lesions may initially be pinkish or even red rather than white. For my experience, i believe that the most important diagnostic criteria for this type of leukoplakia, which should be recognized early, are its proliferate and multifocal nature. This is largely due to the overlapping clinical and pathologic early features with conventional multifocal leukoplakia with dysplasia. You can also get them on the inside of your cheeks. It has a number of possible causes, including repeated injury or irritation. Proliferative verrucous leukoplakia misdiagnosed as oral leukoplakia. With leukoplakia lookohplaykeyuh, thickened, white patches form on your gums, the insides of your cheeks. Nov 10, 2016 leukoplakia of the anterior floor of the mouth and undersurface of the tongue is strongly associated with malignant potential. An aggressive form of oral leukoplakia thomas p shopper, robert b brannon and william h stalker thomas p. Proliferative verrucous leukoplakia is a rare and distinct variant of oral leukoplakia. 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.
Leukoplakia is a condition wherein white or gray patches appear in some parts of the mouth, predominantly in the buccal mucosa and the tongue. Oral leukoplakia may occur at any site in the oral cavity, e. Leukoplakia is a condition in which thick, white or grayish patches form usually inside your mouth. Premalignant changes arising in other oral lesions are uncommon. Leukoplakia could be classified as mucosal disease, and also as a premalignant condition. Since then, various published case series have presented pvl as a. 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. 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.
Proliferative verrucous leukoplakia pvl is a rare oral leukoplakia and has four features such as chronic proliferation, multiple occurrences, refractoriness to treatment and high rate of malignant transformation. Proliferative verrucous leukoplakia med oral patol oral cir bucal. An update keerthi muddana1, deepsagar thadudari2, aruna kumari maloth3, gouri pupala4, nandan srk5 abstract. Proliferative verrucous leukoplakia pvl is a rare form of oral leukoplakia, which was first described in 1985 by hansen et al. Proliferative verrucous leukoplakia a clinico pathological. Diode laser surgery in the treatment of oral proliferative verrucous. Proliferative verrucous leukoplakia is a multifocal and progressive lesion of the oral mucosa, with unknown etiology, and. But other irritants can cause this condition as well.
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