A Villa1,2, R S Menon2, A R Kerr3, F De Abreu Alves4, A Guollo4, D Ojeda5, S B Woo1,2. 1. Division of Oral Medicine and Dentistry, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA. 2. Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA. 3. Department of Oral & Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, NY, USA. 4. Stomatology Department at AC Camargo Cancer Center, Sao Paulo, Brazil. 5. Department of Comprehensive Dentistry, School of Dentistry, UT Health San Antonio, San Antonio, TX, USA.
Abstract
OBJECTIVE: We aimed to characterize proliferative verrucous leukoplakia (PVL) from a clinical and histopathological 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 histopathological 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 multisite and non-contiguous lesions comprised 57.1% (24/42) and 35.7% (15/42) of PVL cases, respectively. 19.1% had prominent erythema (erythroleukoplakia). The most common histopathological 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.
OBJECTIVE: We aimed to characterize proliferative verrucous leukoplakia (PVL) from a clinical and histopathological 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 histopathological 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 multisite and non-contiguous lesions comprised 57.1% (24/42) and 35.7% (15/42) of PVL cases, respectively. 19.1% had prominent erythema (erythroleukoplakia). The most common histopathological 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.
Authors: Lester D R Thompson; Sarah G Fitzpatrick; Susan Müller; Ellen Eisenberg; Jasbir D Upadhyaya; Mark W Lingen; Nadarajah Vigneswaran; Sook-Bin Woo; Indraneel Bhattacharyya; Elizabeth A Bilodeau; Roman Carlos; Mohammed N Islam; Marino E Leon; James S Lewis; Kelly R Magliocca; Haresh Mani; Mitra Mehrad; Bibianna Purgina; Mary Richardson; Bruce M Wenig; Donald M Cohen Journal: Head Neck Pathol Date: 2021-01-07