Vocal fold leukoplakia: physicians' perspectives on diagnosis and management

Vocal fold leukoplakia (VFL) has a potential risk of malignant transformation making consistent diagnostic and treatment management essential. Clinical routines vary as clear guidelines are lacking.

This study aimed to explore current practices in diagnosis, treatment and follow-up of VFL and identify variations in patient care.

Between March and September 2024, 55 physicians involved in the management of VFL in Sweden completed a structured 22-question survey. Distributed via the Swedish Phoniatric Association, it included multiple-choice and open-ended questions on diagnostic tools, treatment and follow-up strategies.

The study revealed considerable variability in VFL management across Sweden. While most respondents used laryngoscopy and stroboscopy, the application of Narrow Band Imaging (NBI) and video documentation differed notably. Surgical strategies varied and showed limited use of photoangiolytic lasers despite proven benefits. Follow-up intervals ranged from no monitoring to long-term cancer-based routines, reflecting a lack of national consensus.

Management guidelines for VFL can be refined by standardizing diagnostic tools and follow-up strategies, expanding access to training and technology, and strengthening professional network.

The heterogeneity in VFL management even among a limited group of specialists suggests that international variation is likely greater and shows the need for clearer, shared guidelines.