- Published: November 13, 2021
- Updated: November 13, 2021
- University / College: University of Alberta
- Language: English
- Downloads: 8
CHAPTER
Definition: Proliferative verrucous leukoplakia (PVL) 2, 3 is a rare oral leukoplakia characterized primarily by chronic proliferation (4. 4-11. 6 years1), exophytosis, confluence, refractoriness to treatment, and extremely high cancerization. It is referred to plainly as ‘ oral leukoplakia’ (OL) before 20041. Thereafter, it is called PVL. The WHO classified it among the “ potentially malignant disorders” 2. When multifocal1, 3, it can be found in the buccal mucosa, gingiva, alveolar ridges, and tongue.
Epidemiology: Oral white lesions have a prevalence of 24. 8% with 0. 2 to 3. 6% of which constitutes leukoplakia2. Over 86% of PVL becomes cancerous in 4. 73 to 6. 12 mean years ( range: 1 to 20 years). It afflicts mostly females2, 1, the elderly (mean age at diagnosis: over 60 years) 2, 1, and non-smokers1. It has a death rate (over 30%) 4.
Provenance: First described in 19851, PVL initially develops as a white hyperkeratotic plaque2. Etiologically, it appears idiopathic, not associated with known cancer risks (e. g. tobacco, viruses, or fungi) 4, 5. Recurrences have been observed1.
Clinical features: PVL lesions occur bilaterally2. It has no distinct histological feature; no obvious growth from single to multiple foci; changing from simple epithelial hyperkeratosis (wart-like, erythroplakic) (Fig. 1) to verrucous hyperplasia or carcinoma or oral squamous cell cancer (OSCC). Genetic profile shows increased TGF-α; deletion or mutation of p16INK4α and P14ARF6. Trans-malignancy time is short (four months).
Prognosis: PVL is largely irreversible3; its prognosis poor2. Surgical treatment is inadequate due to high recurrence rate1, 5. Its trans-malignancy rate (40-100%1 and progression rate of 0. 13-17. 5%2) is predictive of oral cancer, particularly OSCC1.
Figure 1 – PVL with Keratosis (wavy) and exophytic wart-like configurations (Source4)
REFERENCES
1. Shaurya M, Ravindra S, Murthy S. Proliferative verrucous leukoplakia of the gingiva: a rare palatal presentation. J Adv Oral Res. 2012 Sep-Dec; 3(3): 43-48 {2229-4120}.
2. Issrani R, Prabhu N, Keluskar V. Oral proliferative verrucous leukoplakia: a case report with an update. Contemp Clin Dent. 2013 Apr-Jun; 4(2): 258-262 {DOI: 10. 4103/0976-237X. 114887}.
3. Ge L, Wu Y, Wu L, Zhang L, Xie B, Zeng X, Lin M, Zhou, Hong-mei Z. Case report of rapidly progressive proliferative verrucous leukoplakia and a proposal for etiology in mainland China. W J Surg Oncol. 2011; 9(1): 26-29 {DOI: 10. 1186/1477-7819-9-26}.
4. Sharma G, Das D, Naik P, Mukherjee J. HPV induced proliferative verrucous leukoplakia: case report. Intl J Healthcare Biomed Res. 2014 Jul; 2(4): 58-62
{ISSN: 2319-7072}.
5. Garcia-Lopez R, Moya A, Bagan JV, Perz-Brocal V. Retroactive case – control study of viral pathogen screening in proliferative verrucous leukoplakia lesions. Clin Otolaryng. 2014; 39(1): 272-280 {DOI: 10. 1111/coa. 12291}.
6. Agarwal N, Panat SR, Gupta P, Aggarwal A, Upadhyay N. Proliferative verrucous leukoplakia: a case report. J Dent Sci Oral Rehab. 2013 Jan-Mar; 41-43.
