Oral Leukoplakia: Considerations about Treatment and Prognosis

Eduardo Madruga Lombardo, Michelle Roxo Gonçalves, Marcus Vinícius Reis Só, Marco Antônio Trevizani Martins, Vinícius Coelho Carrard

Abstract


Oral leukoplakia is a predominantly white, non-removable, macule or plaque, that cannot be characterized as any other definable lesion. Its main risk factor is tobacco smoking. Any site of oral mucosa may be affected and lesions present a risk of malignant transformation. Several treatment approaches are available, being the surgical remotion the most used. Aim: to review the literature about therapeutic approaches and prognosis of oral leukoplakia. Results: besides conventional surgical excision, alternative surgical treatments such as the vaporization of the lesion using carbon dyoxide laser and cryosurgery have been used. Non-surgical treatments involve the application of retinoids, beta-carotene, bleomycin or drugs associated to photodynamic therapy. The choice of treatment is based on clinical experience of professional, lesion size and critical judgment of costbenefit. After partial remotion, lesions may increase, decrease or remain stable in size. Changes in size or surface might indicate malignant transformation. Total remotion is not capable to avoid that risk, neither the possibility of local recurrence or appearance of new lesions. Lesions located in the tongue and in the floor of the mouth, as well as lesions measuring more than 2 cm2 appears to have a worse prognosis. Conclusion: the largest clinical experience and the possibility of microscopic evaluation of all surgical specimens favor the use of conventional surgical removal. However, it is important to highlight that total remotion of the lesion does not eliminate the possibility of recurrence or malignant transformation, which are unpredictable, regardless of the chosen treatment. Therefore, oral leukoplakia patients should be submitted to a strict follow up program, aiming the early detection of malignization.

Keywords


Mouth diseases; Diagnosis, oral; Leukoplakia, oral

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