From the Guidelines
Oral leukoplakia is most effectively treated with photodynamic therapy (PDT) as a first-line treatment, considering its minimally invasive nature, efficacy, and low risk of systemic side effects and disfigurement, as recommended by recent guidelines 1. The primary treatment involves removing the causative factors, particularly tobacco and alcohol use, which should be discontinued immediately. For mild cases, regular monitoring by a dentist or oral surgeon every 3-6 months is recommended to check for any changes.
- Surgical removal is often necessary for concerning lesions, which can be done through conventional surgery, laser therapy, cryotherapy (freezing), or electrocautery.
- Following removal, the tissue is typically sent for biopsy to rule out malignancy.
- Some cases may benefit from topical retinoids like tretinoin 0.05% gel applied twice daily for 2-3 months, or systemic retinoids such as isotretinoin 30-50mg daily for persistent or widespread lesions, though these have side effects including dry skin and lips.
- Photodynamic therapy is another option for certain cases, with topical 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) being a preferred approach due to its efficacy and low risk of side effects 1. Even after successful treatment, continued monitoring is essential as leukoplakia has a recurrence rate of approximately 30% and carries a risk of malignant transformation, especially in cases involving the floor of the mouth or tongue, as noted in recent studies 1.
- Maintaining good oral hygiene and regular dental check-ups are important supportive measures throughout treatment. It is crucial to consider the clinical and histopathological characteristics of the patients, including sex, age, lesion size and type, and grade of dysplasia, when determining the best course of treatment, as emphasized in the guidelines 1.
From the Research
Treatment Options for Oral Leukoplakia
- Surgical interventions, including laser therapy and cryotherapy, have been used to treat oral leukoplakia, although their effectiveness has not been studied in randomized controlled trials (RCTs) with a no treatment or placebo arm 2
- Topical application of vitamin A has been evaluated as a treatment for oral leukoplakia, with some studies suggesting a limited effect in controlling the condition 3
- Other medical and complementary treatments that have been tested for oral leukoplakia include beta carotene, non-steroidal anti-inflammatory drugs (NSAIDs), herbal extracts, and bleomycin, although the evidence for their effectiveness is limited and often uncertain 2
- Chemoprevention modalities, such as systemic and topical agents, have emerged as a promising approach to inhibit the carcinogenesis process in oral leukoplakia, although more research is needed to identify effective agents and biomarkers for predicting treatment response 4
Management and Prevention
- Early diagnosis and effective treatment are thought to be of paramount importance to improve outcomes for oral leukoplakia 5
- Management for oral leukoplakia includes surveillance, excision, and laser surgery, as well as local and systemic approaches to chemoprevention 5
- Cessation of risk factors, such as smoking, is also an important aspect of preventing the development of oral cancer, although its effectiveness has not been assessed in RCTs 2
- Identifying new chemopreventive agents and biomarkers for predicting treatment response should be a focus of future research 4
Clinical Features and Risk Factors
- Oral leukoplakia manifests differently in smokers and non-smokers, with dysplastic lesions being more frequent in male smokers and non-smoking females 6
- Being a male smoker, being female, being younger, and having smaller lesions were associated with dysplastic features in oral leukoplakia 6
- The most frequent anatomical sites of dysplastic lesions were the floor of the mouth in smokers and the tongue in non-smokers 6