1
36 yo female; 2 young children; biopsy
diagnosis 1 year ago = severe dysplasia
2
3
Proliferative Verrucous
Leukoplakia
(PVL)
What is this and how will it affect
my practice?
PROLIFERATIVE
VERRUCOUS
LEUKOPLAKIA (PVL)
• High risk oral white lesion
• Progression from hyperkeratosis to
squamous cell carcinoma
• HPV (subtype 16/18) may be a
causative factor
4
PROLIFERATIVE
VERRUCOUS
LEUKOPLAKIA (PVL)
University of Minnesota Study
• Females 2:1 Males
• Each subsequent biopsy is likely
to be a higher grade (even if
from another location)
• Gingiva is the most likely location
• Smoking plays no or a minor role
PROLIFERATIVE
VERRUCOUS
LEUKOPLAKIA (PVL)
• No absolutely predictive histologic
pattern
• No test now available to perform
to prove likely progression
• Must be re-evaluated very
frequently and totally removed if
recurs
PROLIFERATIVE
VERRUCOUS
LEUKOPLAKIA (PVL)
• High rate of “field cancerization”
• >50% developed further SCC in
other parts of the oral cavity
• Supports hypothesis of an infectious
agent, such as HPV
Bagan, J.V., et al.
Oral Oncology (2004):40;440-443
What’s the relationship of
Human Papilloma Virus to
oral cancer?
• Not really sure, but there’s a lot of
activity and lots of speculation
• HPV is now accepted as the causal
agent of cervical cancer
• HPV appears to be involved in the
etiology of cancer of the oral cavity
“HPV appears to play an etiologic role in
many cancers of the oropharynx and
possibly a small subgroup of cancers of the
oral cavity. The most common HPV type in
genital cancers (HPV16) was also the most
common in these tumors.”
Herrero, R et al.
Journal of the National Cancer Institute
December 2003; 95:1772-83
“Our results suggest an association of oral
carcinogenesis and infection with the high-
risk HPV types 16 and 18.”
Ostwald, C et al.
Med Microbiol Immunol (Berlin)
August 2003; 192:145-8
5
DANGER SIGNALS!!
• NO CAUSE
• CAUSATIVE AGENT CARCINOGEN
• LOCATION
• ULCERATION, INDURATION,
REDNESS (ERYTHROPLAKIA)
6
ORAL MUCOS