From the Guidelines
Leukoplakia should be treated with topical 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) as it is a minimally invasive approach with efficacy and low risk of systemic side effects and disfigurement. This condition is characterized by white or gray patches on the tongue, inside of the cheek, or on the gums, which cannot be scraped off and cannot be attributed to any other specific disease. These patches form due to chronic irritation of the mucous membranes, commonly from tobacco use, alcohol consumption, rough teeth, ill-fitting dentures, or chronic cheek biting [ 1 ]. While most cases are benign, approximately 5-17% of leukoplakia lesions may develop into oral cancer over time.
Diagnosis and Treatment Considerations
- Leukoplakia diagnosis involves clinical examination and potentially biopsy to rule out other conditions and assess for malignant transformation.
- Treatment primarily involves removing the source of irritation—quitting tobacco, reducing alcohol intake, fixing dental issues—and may include medication or surgical removal for persistent lesions.
- Photodynamic therapy (PDT) has emerged as a viable treatment option, with studies showing its effectiveness in managing oral leucoplakia [ 1 ].
- Regular follow-up examinations are essential as leukoplakia can recur, and early intervention is crucial to prevent potential progression to oral cancer.
Photodynamic Therapy (PDT) for Leukoplakia
- Topical ALA-PDT is recommended due to its minimally invasive nature and low risk of systemic side effects [ 1 ].
- Clinical effects of PDT on oral leukoplakia have shown promising results, with significant reduction in lesion size and prevention of recurrence [ 2 ].
- The procedure involves applying a photosensitizer, such as 5-aminolevulinic acid, to the affected area, followed by exposure to a specific wavelength of light, which induces a reaction that targets and destroys abnormal cells.
From the Research
Diagnosis of Leukoplakia
- Leukoplakia is diagnosed through incisional biopsy with scalpel and histopathological examination of the suspicious tissue, which is still the gold standard for diagnosis 3
- The term leukoplakia should be replaced by the diagnosis obtained histologically when a biopsy is taken 4
Treatment of Leukoplakia
- There is no consensus on the most appropriate treatment for leukoplakia, with various non-surgical and surgical treatments reported 3
- Non-surgical treatments, such as vitamin A and retinoids, beta carotene, and bleomycin, have shown significant rates of clinical resolution, but no evidence of effective prevention of malignant transformation and recurrence 5, 6
- Surgical treatments, including laser therapy and cryotherapy, have not been studied by means of a randomized controlled trial (RCT) with a no treatment/placebo arm 5, 6
- Conventional surgery has its own limitations with respect to the size and site of the lesion, but laser surgery has shown some encouraging results 3
Management of Leukoplakia
- Cessation of tobacco habits is an effective measure in reducing the incidence of leukoplakia and oral cancer 4, 7
- Screening for oral precancer may be indicated in individuals at risk 4
- Referring patients to a smoker's clinic can help improve the effectiveness of managing patients with oral precancer to quit smoking 7
- Follow-up of patients with leukoplakia is important, but there is no universal consensus on the duration or interval of follow-up 3