Leukoplakia is a pre-cancerous lesion of the oral cavity

1. MANAGEMENT OF
LEUKOPLAKIA
Shashank Trivedi
(110301192)

2. WHAT IS LEUKOPLAKIA
Leukoplakia is defined as “A predominantly white
lesion of the oral mucosa that cannot be
characterized as any other definable lesion”.
It is the most common pre-malignant lesion of
the oral mucosa with a malignant potential of 15.6
to 39.2%.

4. Extrinsic:
-Smoking
-Tobacco
-Spirit
-Sepsis(HPV/Candidiasis)
-Sunlight
-Sharp Teeth
-Spices
ETIOLOGICAL FACTORS
Intrinsic:
-Genetics
-Old Age(>45 years)
-Nutrition
-Immunosuppression

5. CLINICAL PRESENTATION
Leukoplakia can be either solitary or multiple.
Leukoplakia may appear on any site of the oral cavity,
the most common sites being: buccal mucosa, alveolar
mucosa, floor of the mouth, tongue, lips and palate.
Classically two clinical types of leukoplakia are
recognised: homogeneous and non-homogeneous, which
can co-exist.

7. TOLUIDINE BLUE
STAINING
 Toluidine blue clinically stains malignant lesions,but not normal
mucosa.The dye is taken up by the nuclei of malignant cells manifesting
increased DNA sysnthesis.
 It serves as a guide to biopsy by localizing tumor cells within the area
of the lesion.
 It uses 1% aq.solution of the dye that is decolorized with 1% acetic acid
 The dye binds to dysplastic and malignant epithelial cells with a high
degree of accuracy.

8. Speckled leukoplakia after Toluidine Blue staining

9. CYTOBRUSH
TECHNIQUE
This technique is more accurate than any other
cytologic technique used in the oral cavity.
This technique uses a brush with firm bristles that
obtains individual cells from the full thickness of
the epithelium.

11. BIOPSY
When the suspicious lesion is identified,an
incisional biopsy using a scalpel or a biopsy forceps
is recommended.
When the lesion is very small,Excisional biopsy is
performed as an investigative procedure and as a
treatment modality.

12. Incisional Biopsy
Histological appearance:
Hyperkeratosis and basal
cell hyperplasia

15. GENERAL
CONSIDERATIONS
 All possible agents leading to white keratotic lesions should be
eliminated(such as sharp teeth/Candidal infection) so as to rule out other
definable lesions.
 In persisting lesions/absence of possible causative factor: Biopsy should
be taken to exclude histologically the presence of a definable lesion and to
establish the degree of epithelial dysplasia.
 Up to 60% of leukoplakias regress or totally disappear if tobacco use is
stopped.

16. MEDICAL MANAGEMENT
(CHEMOPREVENTION)
Carotenoid and Retinoid:
Eg:β-Carotene
Vitamin E
Selenium
Canthaxanthin
Astaxanthin
phytoene

17. 1. Vitamin A
75000-300000 IU/day for 3-18 months
2. 13-cis retinoic acid
1.5mg/Kg per day for 3 months
Followed by
0.5mg/Kg per day for 9 months
3. β Carotene
30mg daily for 3-6 months

18. 4. Fenretinide
-Synthetic retinoid
-200mg/day
-Reduces the relapse and appearance of new
leukoplakias
5. Vitamin E
800 IU/day

19. PHOTODYNAMIC THERAPY
(PDT)
PDT involves using specific wavelength of laser light to
activate a photosensitizing drug which is administered
systemically and is retained selectively in the lesion.
This triggers a cold photochemical reaction resulting in the
generation of reactive products such as singlet oxygen that
damages tissue

21. Advantages:
Inactivation of clinically subtle/undetectable
alteration.
Sparing of normal tissue.
Minimal morbidity.
 Disadvantage:
Cutaneous photosensitivity which can persist
for several months after administration of the
photosensitizer which can be a major problem in
the Indian Subcontinent,where oral cancer is most
common.

22. TOPICAL
CHEMOTHERAPY
Involves the use of Podophyllin solution or
Bleomycin.
According to the studies conducted by Kovacs et
al,1962 and Hammersley el al,1985:These drugs
have induced some regression or even total
resolution of dysplasia and of clinical lesions.

24. OTHER ALTERNATIVE
MODALITIES OF TREATMENT
Green Tea
It has an anti-inflammatory action,antioxidant action
and Anticancer action.
Oral Lycopene
in the dose of 8 mg/day is beneficial in the
treatment of oral leukoplakia.

25. SURGICAL LINE OF
TREATMENT
If the lesion is very small,it should be excised as a part of
investigation and as a treatment option.
Complete surgical removal (leaving free-lesion borders) is
recommended in cases with epithelial dysplasia.
Even if the lesion is completely removed, long term review is still
usually indicated since leukoplakia can recur.

27. CONCLUSION
 There is no known therapy to prevent development of oral leukoplakia and
there is no known therapy to prevent oral squamous cell carcinoma developing
from oral leukoplakia.
 It has been demonstrated that a healthy life style and the abstinence of
tobacco are the best way to prevent both. Fresh fruits and vegetables may have
a protective effect in the primary prevention of oral cancer and precancer.
 Early diagnosis and treatment of leukoplakia, can reduce the high rates of
oral cancer morbidity and mortality in many countries.

28. BIBLIOGRAPHY
 Textbook of Oral Medicine and
Radiology- Dr.Ravikiran Ongole
 Textbook of Oral Medicine- Burkitt
 Textbook of Oral Pathology-
Shafer’s