Leucoplachia verrucosa proliferativa. Analisi retrospettiva di 12 casi

Objectives. Proliferative verrucous leukoplakia (PVL) is a potentially malignant disorder characterized by highly aggressive behavior and a marked tendency to neoplastic transformation. In this retrospective study, we analyzed the epidemiologic, clinical and histopathological features of 12 cases of PVL with particular emphasis on the type and outcome of treatment. Materials and methods. Using the original diagnostic criteria proposed by Hansen, we selected 12 patients with PVL who were referred to the Unit of Oral Medicine and Oral Pathology (Odontostomatology Department) of the University Hospital of Parma between January 1993 and January 2010. Results. Ten patients (83.3%) were females; the mean age of the total group was 70.1 years. The buccal mucosa, tongue, and adherent gingiva were the most frequently involved oral sites. Eight patients (60.0%) developed an oral carcinoma during the follow-up. The mean interval between the first visit and the diagnosis of malignancy was 33.8 months. The cancers involved the tongue (3 cases), buccal mucosa (2 cases), gingiva (2 cases), and hard palate (1 case). Different therapeutic approaches were utilized: medical therapy with topical retinois or topical clobetasol, surgical removal of the lesions with traditional cold-blade technique, quantic molecular resonance scalpel, Nd:YAG laser, and Er:YAG laser vaporization. Only one patient was disease-free at the last follow-up visit. Conclusions. This experience confirms the high rate of malignant transformation and recurrence associated with PVL. None of the therapeutic approaches proved to be completely effective. Therefore, patients with PVL need close follow-up (every 3-4 months) to insure early detection of malignant lesions.