Laser management of oral leukoplakias: A follow-up study of 70 patients

Objectives/Hypothesis: To assess the efficacy of laser therapy for the mana gement of premalignant oral lesions. Study Design: The study group consiste d of seventy consecutive laser-treated patients with oral leukoplakia. The microscopic diagnosis included idiopathic focal keratosis, dysplasias of al l grades, and verrucous hyperplasia (proliferative verrucous leukoplakia). Thirty-nine patients had some degree of microscopic dysplasia and six demon strated highrisk proliferative verrucous leukoplakia. The clinical appearan ces of the lesions were white (homogeneous leukoplakia) in 48, red and whit e (erythroleukoplakia) in 8, and verrucous in 14. There were 38 men and 32 women in this group. The average age was 63 years (range, 31-90 y). Methods : Lasers employed were the CO2 and Nd:YAG lasers, and standard laser safety protocols were used, Results: There was no postoperative infection, hemorr hage, or paresthesia. Two patients developed pyogenic granulomas in their s urgical sites, Fifty-five of 70 patients were followed for more than 6 mont hs; follow-up averaged 32 months (range 6-178 mo), Twenty-nine patients had complete control of their lesions; 19 patients had small recurrences remov ed with subsequent laser surgeries, leading to control; 2 patients had comp lete recurrences; and 5 patients developed squamous cell carcinoma at the l esion site, Verrucous lesions had an especially high rate of recurrence (83 %), with 9 of 12 ultimately controlled with subsequent surgeries. Conclusio ns: Laser surgery of oral leukoplakia is an effective tool in a complete ma nagement strategy that includes careful clinical follow-up, patient educati on to eliminate risk factors and report suspicious lesions, and biopsy of s uspicious lesions when appropriate. How ever, recurrence and progression to cancer remain a risk.