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Proliferative verrucous leukoplakia - Oral Mucosal Lesion
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Proliferative verrucous leukoplakia - Oral Mucosal Lesion

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Contributors: Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc
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Synopsis

Proliferative verrucous leukoplakia : Oral white plaque
Proliferative (verrucous) leukoplakia (PVL) is a clinico-pathologic entity and a particular form of high-risk leukoplakia characterized by white plaques on the buccal mucosa that are persistent, progressive, and often multifocal, that is associated with a high rate of malignant transformation (70% to 100%). Malignancy takes the form of squamous cell or verrucous carcinoma. They begin as white plaques that over years develop exophytic and verrucous areas. However, not all cases of PVL have verrucous areas. There is likely some overlap between lesions of "verrucous leukoplakia" that are generally localized and PVL.

Females are affected 4-5 times more often than men. Since these lesions are progressive, patients often present with a 1-2 decade history of these lesions being present and patients are typically in the seventh decade and older. Unlike localized leukoplakia, tobacco use is noted in less than one-third of cases.

Codes

ICD10CM:
K13.21 – Leukoplakia of oral mucosa, including tongue

SNOMEDCT:
274134003 – Leukoplakia

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Lichen planus presents as reticular, erythematous / erosive, and ulcerative areas of the mucosa. In the past, there was a subcategory of "plaque-type lichen planus" that is better classified as "leukoplakia in association with lichen planus." Because PVL is often bilateral, lesions have been misdiagnosed as lichen planus in the past, leading to the misapprehension that many lichen planus lesions progress to carcinoma. 
  • Candidiasis may be extensive, but it would not be persistent for years without remission and would resolve with anti-fungal therapy.
  • Squamous cell carcinoma
  • Genodermatoses such as white sponge nevus may be extensive but usually present early in life.
  • Chronic bite keratosis (from cheek chewing) may be extensive but usually looks shaggy in appearance, and the location of lesions is limited to mucosa that can be bitten or raked against existing teeth. 
  • Localized leukoplakia is present only on one site.
  • Secondary syphilis  

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated:01/17/2021
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Proliferative verrucous leukoplakia - Oral Mucosal Lesion
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A medical illustration showing key findings of Proliferative verrucous leukoplakia : Oral white plaque
Clinical image of Proliferative verrucous leukoplakia - imageId=2517899. Click to open in gallery. caption: 'White, verrucous, and rugose papules with intervening red stippling and papules on the tongue. Note also the red and white crusted plaque on the lower lip.'
White, verrucous, and rugose papules with intervening red stippling and papules on the tongue. Note also the red and white crusted plaque on the lower lip.

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