Laser surgical management of proliferative verrucous leukoplakia: a case report

Proliferative verrucous leukoplakia (PVL) is an oral potentially malignant disorder that mainly affects middle-aged and older women. Its etiology remains unknown, and the disorder is not associated with known risk factors such as tobacco use. PVL lesions are characterized by a progressive, persistent, and recurrent nature, a fact that renders treatment challenging. This case report describes the treatment of PVL using a high-power laser surgical approach. A 54-year-old male smoker reported a chief concern of persistent white plaques in the mouth that had been present for approximately 5 years but had no associated symptoms. Intraoral clinical examination revealed white plaques of varying thicknesses whose surfaces were flat in some areas and granular in others; the lesions had irregular margins and involved the buccal mucosa bilaterally, extending to the retromolar trigone, oropharynx, hard palate, gingiva, and alveolar ridge. Incisional biopsies were performed in the bilateral buccal mucosa and oropharynx, and histopathologic analysis of the tissue revealed hyperkeratosis associated with mild epithelial dysplasia. The combination of clinical data and histopathologic findings led to the diagnosis of PVL. The patient was monitored, and additional biopsies were required over time. Due to the extent of the lesions and their nonhomogenous appearance, the patient was referred for evaluation and surgical management. A series of 9 surgical interventions with a high-power (980-nm) diode laser, operated in continuous mode at a power of 1.5 W, were performed at intervals of 45 to 60 days. Regular monitoring continues at 3-month intervals, and, 18 months after the first treatment, the patient has remained satisfied with the results, shows no significant recurrences, and has successfully reduced his tobacco use. Early diagnosis and continuous follow-up of PVL are essential to minimize the risk of malignancy and to ensure selection of the most appropriate therapeutic option. The results in this case add to the evidence that high-power laser therapy is an effective alternative for controlling these lesions.