Townsend Melanie, Kejner Alexandra E, Nourollah-Zadeh Farzad, Rizzante Fabio A P, Woods Tina R, Rathore Sonali, Alterman Douglas, Teich Sorin, Albergotti William G, Newman Jason G, Yoon Angela J
Department of Otolaryngology Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, KY, United States.
Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States.
Front Oncol. 2024 Nov 15;14:1473889. doi: 10.3389/fonc.2024.1473889. eCollection 2024.
Proliferative verrucous leukoplakia (PVL) is an aggressive and distinct type of oral precancerous lesion characterized by warty surfaced white plaque diffusely involving oral mucosa. Surgical excision is the treatment of choice. However, PVL has persistent and recurrent growth patterns, requiring multiple surgical procedures. Surgical intervention is especially challenging if PVL extends between teeth limiting access. These interproximally located lesions have a high propensity to undergo malignant transformation. We report a case of a 53-year-old man with recurrent PVL diffusely covering the maxillary and mandibular gingiva. Despite complete surgical excisions, PVL recurred, and a focal area in the interproximal mandibular gingiva progressed to invasive squamous cell carcinoma requiring marginal resection. The remaining PVL areas were treated with topical imiquimod (toll-like receptor 7 agonist) for six months, resulting in complete clinical and histological resolution. Topical agents can cover a larger surface area and penetrate in between interproximal areas. Importantly, it allows for maximal local exposure with minimal systemic toxicity, essential for long-term treatment and prophylactic use of the agent to prevent relapse.
增殖性疣状白斑（PVL）是一种侵袭性且独特的口腔癌前病变，其特征为表面呈疣状的白色斑块，广泛累及口腔黏膜。手术切除是首选治疗方法。然而，PVL具有持续和复发的生长模式，需要多次手术。如果PVL在牙齿之间扩展，限制了手术入路，手术干预尤其具有挑战性。这些位于牙间隙的病变极易发生恶变。我们报告一例53岁男性，复发性PVL广泛覆盖上颌和下颌牙龈。尽管进行了完整的手术切除，PVL仍复发，下颌牙间隙牙龈的一个局灶性区域进展为浸润性鳞状细胞癌，需要进行边缘切除。其余PVL区域外用咪喹莫特（Toll样受体7激动剂）治疗6个月，临床和组织学均完全消退。外用药物可以覆盖更大的表面积，并渗透到牙间隙区域。重要的是，它能在全身毒性最小的情况下实现最大程度的局部暴露，这对于长期治疗以及预防性使用该药物以防止复发至关重要。
