Proliferative Verrucous Leukoplakia

Etiology • Some associated with human papillomavirus types 16 and 18 • Role of tobacco and other risk factors • Represents a clinicopathologic spectrum of disease • Multiple lesions develop from hyperkeratosis and/or verrucous
hyperplasia to verrucous carcinoma or papillary squamous cell carcinoma

Clinical Presentation • Slowly progressive and persistent • Initially a flat hyperkeratotic to warty surface • Surface may be friable • Typically multiple and recurrent • Seen in middle-aged to elderly patients
Diagnosis • Based upon appearance, clinical course, and microscopic
diagnosis (ie, clinical-pathologic correlation) • Microscopic diagnoses include epithelial hyperplasia, hyper-
keratosis, verrucous hyperplasia, “atypical papillary-verrucal proliferation,” verrucous or well-differentiated squamous cell carcinoma
Differential Diagnosis • Idiopathic leukoplakia • Oral warts/condyloma • Verrucous/squamous cell carcinoma
Treatment • Surgical excision
• Mucosal stripping or excision for benign lesions • Wide excision to resection for advanced lesions • Laser ablation for benign/atypical lesions
• Systemic retinoids to control keratosis