Proliferative verrucous leukoplakia: a follow-up study of 54 cases.

OBJECTIVES: Proliferative verrucous leukoplakia is a unique form of oral leukoplakia that has a high risk for becoming dysplastic and transforming into squamous cell carcinoma. The purpose of this review is to update patient profiles, pathogenesis, and survival.

STUDY DESIGN: Fifty-four patients with proliferative verrucous leukoplakia (17 from a previous report) were followed prospectively in our clinic for a mean of 11.6 years after initial biopsy.

RESULTS: In the patient population studied, the mean age was 62 years, and women outnumbered men 4 to 1. Multiple intraoral sites were involved (mean, 2.6 per patient); the most common sites were buccal mucosa in women and tongue in men. In a mean time of 7.7 years, 70.3% of the patients developed a squamous cell carcinoma at a proliferative verrucous leukoplakia site, most frequently the gingiva and tongue. Twenty-one of the patients with proliferative verrucous leukoplakia died of proliferative verrucous leukoplakia-associated carcinoma. Only 31% of the 54 patients used tobacco in any form. Radiation did not appear to enhance surgical control.

CONCLUSIONS: Proliferative verrucous leukoplakia is a high risk precancerous lesion with a high mortality rate. Because of both the propensity for progression to dysplasia and malignancy, as well as a high recurrence rate, these patients must be treated aggressively and followed carefully.