Oral leukoplakia is the most common premalignant lesion or disorder of the oral mucosa. The annual malignant transformation rate amounts approximatey 1%-2%. Of the many predictors of future cancer development, including a vast number of genetic and molecular biomarkers, the presence and degree of epithelial dysplasia is still the most important one. Nevertheless, malignant transformation may also occur in non-dysplastic leukoplakias. Furthermore, dysplastic leukoplakias in non-smokers carry a higher risk of cancer development.Spontaneous regression is rather rare. In small lesions, e.g. less than 2-3 cm, the taking of an excisional biopsy is recommended. In case of larger or multiple lesions surgical removal may be limited to the clinically most suspicious area, if any, and may be combined with CO2 laser evaporation. Because of the lack of prospective randomized trials it is questionable whether removal of leukoplakias does truly eliminate or reduce the risk of future development of oral cancer. At the same time, most patients ask for active treatment, if feasible, instead of just a wait-and-see strategy. All patients with leukoplakias, being actively treated or not, should be followed-up with intervals of three to six months, depending, a.o. of the histopathological findings.
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