TOPICAL BLEOMYCIN FOR THE TREATMENT OF DYSPLASTIC ORAL LEUKOPLAKIA

BACKGROUND, Because malignant transformation of dysplastic oral leukop lakia has been reported in up to 43% of cases, these lesions must be m anaged. METHODS. This study evaluated the use of topical 1% bleomycin in dimethylsulfoxide for the treatment of dysplastic oral lesions. Ble omycin was applied once daily for 14 consecutive days to lesions of th e oral mucosa in 19 patients. Immediate posttreatment biopsies and the clinical response were evaluated and clinical follow-up was conducted for as long as possible. RESULTS. The mean age of the patients at dia gnosis was 59.4 years and 74% were tobacco users. Seventy-five percent of patients had resolution of dysplasia at follow-up biopsy, with a m ean improvement of two histologic grades of dysplasia after topical ch emotherapy. Ninety-four percent of the patients attained at least part ial responses. After a mean follow-up period of 3.4 years, 31.6% of pa tients had no clinically visible lesions and 47.4% of patients had cli nically benign lesions of homogeneous leukoplakia or minimal visible l eukoplakia. In 2 patients (11%) malignant transformation occurred a me an of 1.75 years after bleomycin treatment. CONCLUSIONS, Topical bleom ycin may prevent the potential progression of leukoplakia through dysp lasia to carcinoma. Close follow-up of all patients with dysplasia is required. Cancer 1998;83:629-34. (C) 1998 American Cancer Society.