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BDS (Hons), MFDS RCS (Ed), MFDS RCS (Eng), FRCPath, PhD, SFHEA, Senior Clinical Teacher and Honorary Consultant in Oral and Maxillofacial Pathology; School of Clinical Dentistry, University of Sheffield
Proliferative verrucous leukoplakia (PVL) is a rare, but relentless, form of leukoplakia, with a high recurrence rate and a tendency to become malignant, either as an oral squamous cell carcinoma (OSCC) or verrucous carcinoma (VC). Its aetiology is mainly unknown, and there is uncertainty around its management owing to its resistance to most treatments with a high rate of recurrence.
CPD/Clinical Relevance:
Understanding PVL is key to making prompt diagnosis and referral for improved outcome of treatment due to its high malignancy transformation rate.
Article
The World Health Organization defines oral leukoplakia (OL) as a white patch that cannot be rubbed off, cannot be characterized clinically or histologically as any other disease, and that is not associated with any physical or chemical causative agent except the use of tobacco.1 Leukoplakia is split into two main groups dependent on its colour and texture: homogeneous and non-homogeneous. Homogeneous OLs are uniform in colour and texture, whereas non-homogeneous OLs show varying colours or textures within the mucosal abnormality.
The estimated worldwide prevalence of OL is 2.6%.2 Although it is difficult to obtain accurate data on its risk of malignant progression, a systematic review by Villa et al found OL to have a malignant potential of 0.6–5% within 5 years from diagnosis if homogeneous, and 20–25% within 5 years from diagnosis if non-homogeneous.3 Oral erythroplakia (OE) is similar to OL except that it is red in colour and associated with a much higher malignancy transformation rate of up to 19.9%.4 These comparisons, along with others from this article, are summarized in Table 1.5
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