Evaluation of surgical excision of non-homogeneous oral leukoplakia in a screening intervention trial, Kerala, India

It is well established that most invasive oral cancers arise from precancer ous lesions such as leukoplakia. erythroplakia and oral submucous fibrosis. One of the approaches for control of oral cancer is to detect oral precanc erous lesions early in their development and prevent their malignant transf ormation to invasive cancer either by chemoprevention or by surgical excisi on of the lesions, with concurrent control of tobacco and alcohol use and o ther specific aetiological factors. However, the value of specific approach es such surgery in long-term control of lesions and prevention of malignant transformation is not known. We describe our experience with cold knife su rgical excision of 59 cases of non-homogeneous leukoplakia of the oral cavi ty diagnosed in the context of a community-based oral cancer cluster random ised oral cancer screening trial ill Kerala, India. Two-thirds of these rev ealed dysplasia on histology, After a minimum follow-up of 12 months (range 12-37 months) after surgical excision, 44 (74.8%) were remaining disease f ree with no evidence of recurrent/new; lesions, during follow-up, three (5% ) developed new luekoplakic lesions, and six (10.1%) developed recurrent le sions: while six (10.1%) could not be traced after treatment. There was no event of malignant change during follow-up. The proportion of subjects rema ining with no evidence of disease at 3 years by Kaplan-Meier method of anal ysis was 62.1% (95% CI: 0.36-0.87). Accrual and long-term follow-up of larg e number of surgically treated cases may provide valuable leads to manageme nt policies of oral leukoplakia, since, as of now, the added value of speci fic treatments over and above primary prevention by tobacco and alcohol con trol remains to be established. (C) 2001 Elsevier Science Ltd. All rights r eserved.