Evaluation, surveillance and treatment of panoral leukoplakia

Leukoplakia is well-recognised as a premalignant condition of the oral mucosa. Despite many attempts to produce definitive laboratory tests for the prediction of those cases of premalignant leukoplakia which may undergo malignant transformation, there is as yet no fool-proof method of clinical and laboratory assessment. The problem is nowhere more manifest than in the management of panoral leukoplakia, especially in frail, elderly and apprehensive patients. In such cases the selection of sites for biopsy and treatment is often more empirical than logical. The introduction of cryosurgical techniques for the treatment of leukoplakia has enabled the surgeon to eradicate panoral white patches in a more conservative fashion. The application of a diagnostic nuclear staining test using toluidine blue dye, coupled with local exfoliative cytology, has provided a system for evaluation and surveillance of panoral leukoplakia which is clinically simple and at least as reliable as any predictive test previously described.