Cryogun cryotherapy is the first-line treatment of choice for oral leukoplakia

Abstract

Oral leukoplakia (OL) is the most common oral precancerous lesion. Histologically, approximately 90% of OL lesions show hyperkeratosis and/or epithelial hyperplasia, 5% show epithelial dysplasia or carcinoma in situ, and another 5% show invasive carcinoma. The malignant transformation rates of OL lesions have been reported to be 1e7% for homogenous thick leukoplakia, and 4e15% for granular or verruciform leukoplakia. 1e3 The relatively high malignant transformation rates of OL lesions highlight the importance of early detection and treatment of OL lesions.Although OL lesions can be eradicated by surgical excision, laser surgery, and photodynamic therapy, cryotherapy is also an effective and alternative treatment modality for OL lesions. 1e5 Cryotherapy is a method that locally destroys lesional tissues by freezing in situ. It has several advantages including being a bloodless treatment, has a very low incidence rate of secondary infections, and has a relative lack of scarring and pain. 1e3 Cryotherapy can be carried out with either a "closed" or an "open" system. 1e3 Closedsystem cryotherapy offers a greater degree of temperature control but requires complex, delicate, and expensive equipment. Open-system cryotherapy involves directly applying the cryogen to the lesion with either a cotton swab 2 or a portable spray apparatus such as a cryogun (Brymill Corp., Ellington, CT, USA). 3 When performing opensystem cryotherapy, it is more difficult to maintain a constant lower temperature in the lesional tissues during the whole treatment period. However, it does not require expensive equipment. Cotton-swab cryotherapy is suitable for the treatment of small OL lesions, 2 but cryogun cryotherapy can be used for the treatment of medium and large OL lesions with either smooth or rough surfaces. 3

Oral Leukoplakia

“…Cheng SJ, Chen HM, Chiang CP. [8] were found that topical 5-aminolevulinic acid-mediated photodynamic therapy (topical ALA-PDT) is very effective for oral erythroleukoplakia and oral verrucous hyperplasia lesions, but is less effective for OL lesions. However, when topical ALA-PDT is combined with cryotherapy, the combination therapy may be an effective treatment modality for OL lesions.…”