Proliferative leukoplakia: proposed new clinical diagnostic criteria

Abstract

Objective

We aimed to characterize proliferative verrucous leukoplakia (PVL) from a clinical and histopathologic standpoint and suggest an updated classification.

Subjects and Methods

Records of patients seen at three oral medicine centers with a clinical diagnosis of PVL were reviewed for clinical and histopathologic features, and malignant transformation (MT).

Results

There were 42 patients (median age: 69 years [range:36-88]; 35 females). 12.2% were current smokers. Family history of cancer was present in 43.7% of patients. Partial demarcation of lesion margins was present in 31.3% of lesions, followed by verrucous (27.5%), smooth (22.7%,) erythematous (22.3%), and fissured (18.3%) appearance. Large and contiguous, and multi-site and noncontiguous lesions, comprised 57.1% (24/42) and 35.7% (15/42) of PVL cases, respectively. 19.1% had prominent erythema (erythroleukoplakia). The most common histopathologic diagnosis at first visit was hyperkeratosis without dysplasia (22/42; 56.4%). MT occurred in 71.4% patients after a median of 37 months [range:1-210] from initial visit; erythroleukoplakia exhibited MT in 100% of cases.

Conclusion

The generic term "proliferative leukoplakia (PL)" may be more appropriate than PVL because 18.3% were fissured and 22.7% erythematous. We also propose the term proliferative erythroleukoplakia to more accurately describe the subset of PL with prominent erythema, which had the highest MT rate.

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