• Isaäc van der WaalEmail author


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.


  1. 1.
    Parashar P. Proliferative verrucous leukoplakia: an elusive disorder. J Evid Based Dent Pract. 2014;(Suppl):147–53.Google Scholar
  2. 2.
    Petti S. Pooled estimate of world leukoplakia prevalence: a systematic review. Oral Oncol. 2003;39(8):770–80.CrossRefPubMedGoogle Scholar
  3. 3.
    Warnakulasuriya S, Ariyawardana A. Malignant transformation of oral leukoplakia: a systemic review of observational studies. J Oral Pathol Med. 2015; doi:  10.1111/jop.12339. Epub ahead of print.
  4. 4.
    Ho MW, Risk JM, Woolgar JA, Field EA, Field JK, Steele JC, et al. The clinical determinants of malignant transformation in oral dysplasia. Oral Oncol. 2012;48(10):969–76.CrossRefPubMedGoogle Scholar
  5. 5.
    William Jr WN. Oral premalignant lesions: any progress with systemic therapies? Curr Opin Oncol. 2012;24(3):205–2010.CrossRefPubMedGoogle Scholar
  6. 6.
    Graveland AP, Bremmer JF, de Maaker M, Brink A, Cobussen P, Zwart M, et al. Molecular screening of oral precancer. Oral Oncol. 2013;49(12):1129–35.CrossRefPubMedGoogle Scholar
  7. 7.
    Chainani-Wu N, Madden E, Cox D, Sroussi H, Epstein J, Silverman Jr S. Toluidine blue aids in detection of dysplasia and carcinoma in suspicious oral lesions. Oral Dis. 2015;21(7):879–85.CrossRefPubMedGoogle Scholar
  8. 8.
    Speight PM, Abram TJ, Floriano PN, James BS, Vick J, Thornhill MH, et al. Interobserver agreement in dysplasia grading: toward an enhanced gold standard for clinical pathology trials. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;120(4):474–82.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Holmstrup P. Can we prevent malignancy by treating premalignant lesions? Editorial Oral Oncol. 2009;45(7):549–50.Google Scholar
  10. 10.
    Anderson A, Ishak N. Marked variation in malignant transformation rates of oral leukoplakia. Evid Based Dent. 2015;16(4):102–3.CrossRefPubMedGoogle Scholar
  11. 11.
    Balasundaram I, Payne KF, Al-Hadad I, Alibhai M, Thomas S, Bhandari R. Is there any benefit in surgery for potentially malignant disorders of the oral cavity? J Oral Pathol Med. 2014;43(4):239–44.CrossRefPubMedGoogle Scholar
  12. 12.
    Kuribayashi Y, Tsushima F, Morita K, Matsumoto K, Sakurai J, Uesugi A, et al. Long-term outcome of non-surgical treatment in patients with oral leukoplakia. Oral Oncol. 2015;51(11):1020–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Kuribayashi Y, Tsushima F, Sato M, Morita K, Omura K. Recurrence patterns of oral leukoplakia after curative surgical resection: important factors that predict the risk of recurrence and malignancy. J Oral Pathol Med. 2012;41(9):682–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Arnaoutakis D, Bishop J, Westra W, Califano JA. Recurrence patterns and management of oral cavity premalignant lesions. Oral Oncol. 2013;49(8):814–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Vladimirov BS, Schiødt M. The effect of quitting smoking on the risk of unfavorable events after surgical treatment of oral potentially malignant lesions. Int J Oral Maxillofac Surg. 2009;38(11):1188–93.CrossRefPubMedGoogle Scholar

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© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.VU University Medical Centre/ACTA, Department of Oral and Maxillofacial Surgery/PathologyAmsterdamThe Netherlands

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