Abstract
Objective: Proliferative verrucous leukoplakia (PVL) is a rare, recalcitrant, and lethal form of leukoplakia necessitating special attention. The purpose of this review is to further educate the otolaryngology community and to characterize the risk factors, clinical course, and optimal treatment for this highly aggressive, premalignant oral lesion.
Method: A retrospective review was performed on all PVL cases treated at WMHC from 1985 to 2010. This data was pooled with additional PVL cases identified following a systemic review of the English-language literature. Only articles addressing epidemiology, histopathology, treatment outcomes, and malignant progression were pooled and analyzed with our data.
Results: A total of 243 PVL cases met inclusion criteria. The mean patient age was 66 years. The majority of patients were female (72%) and nonsmokers (64.6%). HPV has not been found to be a risk factor. The average length of follow-up was 5.5 years, with an average of 10.7 biopsies per patient during this period. PVL exhibits histopathologic features along a progressive spectrum, evolving from leukoplakia and verrucous hyperplasia eventually to invasive carcinoma. Definitive treatment was rarely successful, with PVL recurrence rates reaching 88%. Rate of progression to verrucous carcinoma or oral squamous cell carcinoma was high (63.6%).
Conclusion: PVL is a rare but recalcitrant form of leukoplakia with a malignant transformation rate reaching 64%. PVL warrants high clinical suspicion, to include a lifetime of close follow-up by a physician well versed in oral carcinoma. Repeat biopsy should be considered an integral part of this routine follow-up.
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