Oral leukoplakia diagnosis and treatment in Europe and Australia: Oral Medicine Practitioners' attitudes and practice

Abstract

The management of oral potentially malignant disorders (OPMD) including oral leukoplakia (OL) is not currently structured according to agreed guidelines. The current report presents survey data gathered from Oral Medicine Practitioners (OMPs) in Europe and Australia and is aimed to investigate attitudes and practice in the diagnosis, risk stratification and treatment of OL. In the presence of a clinical provisional diagnosis of OL, respondents reported always undertaking biopsy in 83% of cases, with most OMPs also relying on diagnostic adjuncts. The potential for malignant transformation is almost invariably assessed through epithelial dysplasia status, with other biomarkers described in the literature used less often. Active treatment of OL was considered mandatory by 20% of OMPs, while others reserve treatment for selected cases only. OMPs are mostly driven to active treatment by lesion‐related features which are frequently jointly considered including lesion site, clinical appearance and dysplasia status. Inconsistent assessment was observed regarding mild dysplasia, lesion size, presence of unavoidable trauma, exposure to tobacco and patient age. Frequently observed geographical variations were seldom statistically significant. In agreement with previous surveys, a lack of consensus around the management of OL was observed, supporting claims from learned academies and societies for treatment guidelines aiming to reduce inter‐practitioner variability.

Predictors of malignant transformation in oral leukoplakia and proliferative verrucous leukoplakia: An observational prospective study including the DNA ploidy status

“…The presence of OED already identifies a subgroup of patients with a high risk of progression to cancer; but finding a biomarker able to detect patients earlier with chromosome instability (CIN)—and for this reason more prone to develop OED itself—would be of utmost value and would allow an even earlier stratification of patients. Currently, no single reliable biomarker is available; clinicians usually consider together several patient‐ and lesion‐related features aimed at stratifying the risk of progression in a single patient; and biomarkers' assessment has still not entered the routine clinical‐practice of Oral Medicine Practitioners (OMPs) 51 . Most studies assessing the predictive value of the DNA ploidy status concluded that it has limited value in predicting progression to cancer as a single biomarker 16,17,20,21 ; the combined use of OED and DNA ploidy has been shown to be a better predictor for identifying low‐risk lesions 18,22 .…”

“…Despite extensive data from the literature, and although it is a more objective technique than OED evaluation, DNA ploidy status, evaluated either by Image or Flow Cytometry (ICM or FCM), is currently routinely assessed in practice by just under 10% of OMPs in Europe and Australia. 51 This could be related to a number of issues: the cost for each test (not greater than €50) is not prohibitive, but both ICM and FCM require facilities unavailable in most laboratories; and, primarily, the prospective validation of a strong predictive role of DNA ploidy is still lacking. Cox regression models based on our results show that DNA aneuploidy might not be as strong predictor as the other variables.…”

Recurrence of Oral Leukoplakia after CO2 Laser Resection: A Prospective Longitudinal Study

“…The role of alcohol in the development of oral leukoplakia is less clear [7][8][9][10][11]. Some authors agree that the combination of tobacco and alcohol does increase the risk of malignant transformation, and that this is probably related (1) to the increased solubility of carcinogens and atrophy of the oral mucosa caused by alcohol, (2) to the mutagenic agents generated in metabolism (acetaldehyde), and (3) to the decreased DNA capacity associated with alcohol consumption [2,10].…”

“…The management of oral potentially malignant disorders (OPMD), including oral leukoplakia (OL), is controversial [ 1 , 2 , 3 ]. Among OPMD, oral leukoplakia remains the most commonly encountered condition in clinical practice [ 4 ].…”

“…As stated in a systematic review by Petti et al 2003 [ 3 ], the worldwide prevalence of leukoplakia ranges between 1.49–2.6%, suggesting that the global number of oral cancer cases associated with oral leukoplakia is likely underreported, particularly in South-East Asian countries and in India. The major aetiological factor in oral leukoplakia is tobacco use [ 1 ]. In a review by González-Moles et al (2018) [ 6 ], it was observed that smokers exhibit a seven-fold greater risk of developing leukoplakia compared to non-smokers, and that this figure progressively increases in relation to the number of years of consumption and the amount of tobacco used on a daily basis.…”