White Lesions in the Oral Cavity
Posted on 6/12/2023 by Greg Kammeyer
|White Lesions in the Oral Cavity
I’m sure you all do oral cancer exams. Remember to palpate the relaxed tongue as cancer can form there too. For me this is the first thing I do, to affirm I don’t miss anything.
I routinely remove while spot lesions which according to Cerero-Lapiedra et al, Oral Medicine and Pathology 2010, white spot lesions occur in 24.8% in of patients. One researcher published in the Oral Maxillofacial Journal, years ago that 16-64% of white spot lesions turn to cancer.
Recently I removed some white spot lesions that came back dysplastic. This was hyperkeratotic proliferative verrucous leukoplakia (PVL) and is a prime example of malignant transformation of white spot lesions. What got my attention was that her prior dentist had been treating them with a laser for years, which didn’t resolve the issue. Oral leukoplakia remains the most frequent potentially malignant lesion in the oral cavity.
The World Health Organization has labeled PVL as “potentially malignant”. Proliferative Verrucous Leukoplakia (PVL) is one of the most common white lesions that turns to cancer. It typically is at multiple sites, rough, raised, on the gingiva and slow growing. It occurs regardless of smoking status, and commonly has a reddened area near it that can progress to squamous cell carcinoma or verrucous carcinoma. The etiology of this lesion is unknown.
For this leukoplakia, malignant transformation is 70-100%. 74.6% of sites become malignant within 6 years. Major criteria to separate it from other less aggressive white spot lesions are: More than 2 different sites, most frequently found in the gingiva, a verrucous area, the lesions spread, and the lesions recur even after excision.
These all start as a simple white plaque. Because of the high rate of transformation, and since the definitive diagnosis is made histologically from a biopsy, a follow-up period of 6 months is recommended. I hope learning about this is useful for your practice regardless of if you biopsy or refer these case types.