From the Guidelines
Leukoplakia is classified into homogeneous and non-homogeneous types, with non-homogeneous having a higher risk of malignant transformation, as defined by the integration of definitions from the Society of Oral Medicine, Chinese Stomatological Association, and World Health Organization (WHO) 1. The classification of leukoplakia is crucial in determining the risk of malignant transformation and guiding treatment approaches. The main types of leukoplakia include:
- Homogeneous leukoplakia: a uniform white patch with well-defined borders
- Non-homogeneous leukoplakia: includes speckled, nodular, and verrucous forms, with a higher risk of malignant transformation The WHO classification system categorizes leukoplakia based on appearance and risk of malignant transformation, while histologically, it is classified according to the degree of epithelial dysplasia: mild, moderate, severe, or carcinoma in situ 1. The presence and severity of dysplasia significantly influence management decisions and prognosis, emphasizing the importance of a biopsy to rule out malignancy and determine the appropriate treatment approach. The clinical management of leukoplakia aims to prevent malignant transformation, with treatment approaches including non-surgical and surgical methods, although photodynamic therapy (PDT) has emerged as a promising alternative treatment with better efficacy and fewer adverse effects 1.
From the Research
Leukoplakia Classification
- Leukoplakia is a condition characterized by an increased risk for malignant transformation, with two clinical variants: homogeneous and non-homogeneous type 2
- The classification of leukoplakia can be based on color, with homogeneous type being predominantly white and non-homogeneous type being mixed white and red 3
- A proposal has been made to simplify and consistency the clinical classification and terminology of oral leukoplakia, including renaming the term hairy leukoplakia to 'EBV-positive white lesion of the tongue (EBVposWLT)' 3
- Leukoplakia can be subclassified into different types, including proliferative verrucous leukoplakia, although this entity is no longer considered a separate entity in some proposals 3
Diagnostic Criteria
- A 2-4 week interval to observe a possible regression or disappearance of a white lesion, after elimination of possible causative factors, is considered a fully acceptable period of time before taking a biopsy 2
- Taking a biopsy in homogeneous leukoplakia and especially non-homogeneous leukoplakia should be a standard rule, with the histologic report including a statement on absence or presence of epithelial dysplasia and an assessment of its severity 2
- The diagnosis of leukoplakia is usually evident from the clinical presentation and histopathology, with treatment depending on demographic, social, clinical, and histopathologic factors 4
Treatment Options
- Topical application of vitamin A has been evaluated as a treatment option for oral leukoplakia, with limited effect in controlling the condition 5
- Vitamin A has also been used in the treatment of vocal fold leukoplakia, with a study showing that it was effective in reducing the size of the lesion in 62% of cases 6
- Surgery is also a common treatment option for leukoplakia, especially in cases where the lesion is persistent or shows signs of dysplasia 6