OVERVIEW

What is oral leukoplakia?

Oral leukoplakia refers to white lesions on the oral mucosa that cannot be scraped off. It is a precancerous condition with the potential to develop into malignant diseases.

What is oral proliferative verrucous leukoplakia?

Oral proliferative verrucous leukoplakia (OPVL) is a rare and highly aggressive type of oral leukoplakia with a strong tendency to become malignant. OPVL is typically multifocal and prone to recurrence.

Who is most likely to develop oral proliferative verrucous leukoplakia?

Oral proliferative verrucous leukoplakia is a rare condition that predominantly affects elderly women.

SYMPTOMS

What are the manifestations of oral proliferative verrucous leukoplakia?

Oral proliferative verrucous leukoplakia generally progresses through four stages:

1. Initially, single or multiple white patches appear on the gums, oral mucosa, or tongue. At this stage, patients usually do not experience significant discomfort but may notice that the affected mucosa feels rough, slightly woody when touched by the tongue, and firmer than the surrounding tissue.

2. Over time, the white patches expand and spread to larger areas of the mucosa.

3. Subsequently, the patches protrude from the mucosal surface, appearing grayish-white or slightly red, with a rough texture and spiky or villous projections. The affected area feels harder to the touch, and patients may begin to experience pain.

4. Finally, the patches may undergo malignant transformation into oral squamous cell carcinoma (SCC).

CAUSES

What are the causes of oral proliferative verrucous leukoplakia?

The etiology of oral proliferative verrucous leukoplakia is unknown. However, unlike conventional leukoplakia, its occurrence has no clear association with smoking, alcohol consumption, or HPV infection.

DIAGNOSIS

How is oral proliferative verrucous leukoplakia diagnosed?

There is currently no unified diagnostic standard in the medical field. Comprehensive diagnosis is usually based on the clinical manifestations of leukoplakia progression and histopathological examination. Early-stage diagnosis is particularly challenging because oral proliferative verrucous leukoplakia closely resembles conventional leukoplakia or oral lichen planus at this stage.

What tests are needed to diagnose oral proliferative verrucous leukoplakia?

After initial diagnosis based on clinical manifestations, medical history, and routine pathological examination, further tests such as exfoliative cytology and toluidine blue staining are required to assess potential malignant transformation. These two tests are minimally invasive.

• Exfoliative cytology: Involves scraping surface cells from the lesion for microscopic examination.

• Toluidine blue staining: The toluidine blue solution is applied to the dried leukoplakia surface. Suspicious areas are then biopsied to confirm malignancy. This superficial biopsy is minimally traumatic and can be performed without anesthesia.

What diseases are easily confused with oral proliferative verrucous leukoplakia?

Early-stage oral proliferative verrucous leukoplakia lacks specificity and must be differentiated from other similar oral mucosal diseases.

• Leukokeratosis: A benign hyperkeratosis caused by chronic mechanical or chemical irritation, presenting as smooth, soft white patches that resolve completely after removing the irritant.

• Leukoedema: Appears as a translucent, gray-white, smooth, veil-like membrane along the occlusal line of premolars and molars. It can be scraped off and may develop a rough, wood-grain texture later.

• White sponge nevus: Presents as gray-white, wave-like folds or grooves with a pearly sheen, feeling spongy and elastic to the touch.

• Fordyce granules: Small, pale-yellow, grain-like ectopic sebaceous glands in the oral cavity, varying in number and causing no discomfort.

• Oral lichen planus: Plaque-type lichen planus is difficult to distinguish from proliferative verrucous leukoplakia. Histopathological examination is recommended for accurate diagnosis. Typically, plaque-type lichen planus affects the tongue dorsum and other oral areas, showing rapidly changing white striations with erythema or erosion. In contrast, oral proliferative verrucous leukoplakia lesions are more localized, non-erythematous, and stable in the short term.

• Oral submucous fibrosis: Commonly affects the buccal mucosa, pharynx, and soft palate. Initial symptoms include small blisters and ulcers, progressing to faint white streaks (cloud-like) and eventually restricted tongue mobility and mouth opening.

• Syphilitic mucous patches: Initially appear as round or oval erythema, later eroding into soft, centrally depressed lesions, often accompanied by skin rashes of syphilis.

TREATMENT

Which department should I visit for oral proliferative verrucous leukoplakia?

Dentistry.

Does oral proliferative verrucous leukoplakia require hospitalization?

Yes.

How is oral proliferative verrucous leukoplakia treated?

There is currently no cure for oral proliferative verrucous leukoplakia. Treatment options may include surgical excision, laser ablation, cryotherapy, radiation therapy, photodynamic therapy, topical bleomycin application, and oral retinoid therapy.

Studies report a 90% recurrence rate regardless of treatment. Therefore, lifelong follow-up is necessary for patients with oral proliferative verrucous leukoplakia, with recommended check-ups every 3–6 months. If adverse changes are detected during follow-up, available treatments should be used to control disease progression.

DIET & LIFESTYLE

What should patients with oral proliferative verrucous leukoplakia pay attention to in their diet?

• Adopt a healthy eating pattern to ensure adequate nutrition and a balanced diet. Breakfast should be high-quality, including staple foods (bread, porridge, etc.) and at least two protein sources (eggs, milk, meat, soy products), along with at least one serving of vegetables or fruits. Nuts are also recommended. Lunch should be sufficient in quantity, with enough staple foods and dishes, and a variety of ingredients. Dinner should be lower in calories, preferably compensating for foods not consumed or insufficiently consumed in the morning or noon, such as vegetables, whole grains, and tubers.

• It is advisable to consume more foods rich in vitamin E, such as sesame seeds, lean meat, lettuce, cabbage, soybeans, peanuts, walnuts, sunflower seeds, egg yolks, and corn.

• It is recommended to eat more foods rich in lycopene and β-carotene, such as various orange and brightly colored vegetables and fruits.

• Stop chewing betel nut and reduce the intake of sour, spicy, hot, numbing, or astringent foods.

What should patients with oral proliferative verrucous leukoplakia pay attention to in daily life?

• Reduce psychological stress and fear of cancer, maintaining a positive and optimistic attitude.

• Schedule regular oral examinations, remove residual roots, crowns, or poorly fitted dental prostheses, get teeth cleaned once a year, and maintain oral hygiene.

• Engage in regular physical exercise, ensure sufficient sleep daily, and learn self-regulation when facing high stress or emotional tension to boost immunity.

PREVENTION

Can oral proliferative verrucous leukoplakia be prevented?

Currently, there is no effective prevention method. Early health education is the best preventive measure. Learning essential healthcare knowledge and maintaining a general awareness of one's health condition can help detect any oral abnormalities early and address them with sufficient attention.

If abnormal keratinization of the mucosa is already observed, while vigilance is necessary, excessive anxiety should be avoided. It is recommended to seek early examination, diagnosis, and intervention at a specialized hospital.

Additionally, maintaining a positive mindset and healthy lifestyle habits is advised to minimize potential causative factors.