What is the diagnosis and treatment for Leukoplakia (white patch or plaque disease)?

From the Guidelines

Leukoplakia, a potentially precancerous condition, should be managed with photodynamic therapy (PDT) as a preferred treatment option due to its minimally invasive nature, efficacy, and low risk of systemic side effects and disfigurement, as supported by recent guidelines 1. The primary cause of leukoplakia is chronic irritation, most commonly from tobacco use (smoking or chewing), but alcohol consumption, chronic cheek biting, rough dental work, and certain infections may also contribute. Management begins with identifying and eliminating the underlying cause, particularly tobacco cessation.

Diagnosis and Treatment Considerations

• Small lesions should be biopsied to rule out malignancy, while larger lesions may require complete surgical removal.
• Regular follow-up examinations every 3-6 months are essential to monitor for changes.
• For persistent lesions, treatments may include topical retinoids, photodynamic therapy, or laser therapy, with PDT being a preferred option due to its advantages 1.
• The condition is concerning because the white appearance results from thickened keratin layers that may hide cellular changes underneath.
• Patients should be advised that even after treatment, there's a risk of recurrence, especially if irritating factors continue, and new lesions may develop in other areas of the mouth, requiring ongoing vigilance and regular dental check-ups.

Photodynamic Therapy (PDT) Guidelines

• Topical 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) has become a recognized therapeutic approach in the management of oral leucoplakia due to its effectiveness and low risk of side effects 1.
• Studies have demonstrated the clinical effects of PDT on oral leukoplakia, showing significant improvement and no recurrence at follow-up 1.
• However, more research is needed to establish universally applicable guidelines for PDT in the management of oral leucoplakia, including standardized parameters and randomized clinical trials with long-term follow-ups 1.

From the Research

Diagnosis of Leukoplakia

• Leukoplakia is a clinical term that refers to a white patch or plaque that cannot be rubbed off and is often associated with an increased risk of oral cancer 2.
• The diagnosis of leukoplakia is typically made based on clinical examination, and a biopsy may be performed to rule out other conditions and to assess for dysplasia or cancer 2.
• The annual percentage of malignant transformation of leukoplakia varies depending on the location and other factors, such as tobacco and dietary habits 2.

Treatment of Leukoplakia

• The primary objective of treating leukoplakia is to prevent the development of oral cancer 3.
• Various treatments have been studied, including topical and systemic vitamin A, beta carotene, and other agents, but the evidence for their effectiveness is limited and inconclusive 3.
• Surgical interventions, such as laser therapy and cryotherapy, have not been studied in randomized controlled trials with a no-treatment or placebo arm 3.
• Cessation of risk factors, such as smoking, is an important aspect of managing leukoplakia, and referral to a smoker's clinic may be beneficial in helping patients quit smoking 4.

Management of Leukoplakia

• Close follow-up of patients with leukoplakia is essential to monitor for changes in the lesion and to detect any potential malignant transformation early 5, 2.
• Patients with leukoplakia should be advised to quit smoking and avoid other risk factors, such as excessive alcohol consumption and poor diet 2, 4.
• Regular screening for oral cancer is recommended for individuals at high risk, including those with a history of leukoplakia or other oral lesions 2, 6.

Risk Factors for Leukoplakia

• Tobacco usage is the most common risk factor for leukoplakia, and smokeless tobacco may be associated with a higher risk of dysplasia than smoked tobacco 6.
• Other risk factors for leukoplakia include excessive alcohol consumption, poor diet, and human papillomavirus (HPV) infection 2, 4.
• Patients with a history of leukoplakia or other oral lesions should be counseled on the importance of quitting smoking and avoiding other risk factors to reduce their risk of developing oral cancer 4, 6.