Excision of Oral Leukoplakias by CO₂ Laser on an Out-Patient Basis: A Useful Procedure for Prevention and Early Detection of Oral Carcinomas

Abstract

Several epidemiologic studies have shown that oral cancer develops among individuals with a prior diagnosis of an oral premalignant lesion. Canceration chance in these patients is 17 %, with the greatest rate occuring in the second year of observation. Based on this data, since 1981, 92 leucoplakias have been treated by out-patient laser surgery at the Istituto Nazionale Tumori of Milano. The therapeutic technique was laser excision to obtain a specimen for histology. Two groups were distinguished according to the diagnostic procedure. Thirtythree lesions (December 1981 to December 1982) were operated on without preliminary histologic examination, on the basis of a simple clinical diagnosis. Since January 1983 all leukoplakias have been biopsied in a systematic way and those negative for cancer treated with laser. Histology of the specimen showed 5 squamous cell carcinomas (15 %) in the group of patients who did not undergo preoperative biopsy. Postoperative histology showed malignancy in 6 of 59 (10.2 %) cases in spite of negative preoperative biopsies. Speckled and erosive leukoplakias had the highest canceration rate. Three of 11 patients with cancer were treated by knife excision or interstitial needle implantation because of margins in tumoral tissue or because they were unvaluable for injury by heat. Results have been satisfactory, only 2 of 54 followed leukoplakias and none of the cancers recurred during a 2 year follow-up.

Does a Pulsed Mode Offer Advantages Over a Continuous Wave Mode for Excisional Biopsies Performed Using a Carbon Dioxide Laser?

“…Previous studies have reported a similar low rate of postoperative bleeding. 23,24 When a CO 2 laser is used for soft tissue surgeries, the conversion of energy into heat produces a lateral thermal damage zone, where no evaluation of the cell morphology is possible because of the denatured tissue. 4,[16][17][18] The simulation of cytologic atypias in the deeper tissue layers also has been described.…”

Oral potentially malignant lesions: first‐level micro‐histological diagnosis from tissue fragments sampled in liquid‐based diagnostic cytology

“…a retrospective review of slides), scalpel biopsy samples might under diagnose up to 4.4% of dysplasias/carcinomas (4), which may be the result of having sampled too limited small areas. False‐negative results are not only occasionally possible from incisional biopsy, but even where dysplasia has been excluded in a leukoplakia by incisional biopsy, studies have shown that the lesions if wholly excised may prove to contain OSCC in up to 10% (15). This is not surprising, given that molecular changes consistent with early malignant changes can be scattered through and beyond a potentially malignant clinical lesion (16–18).…”

Comparison of pain and swelling after removal of oral leukoplakia with CO2 laser and cold knife: A randomized clinical trial

“…Some authors have examined postoperative pain in the surgical treatment of soft tissue lesions (11,20), though there are few comparative studies on the different surgical techniques in relation to postoperative pain and swelling in oral leukoplakia patients.…”