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Malignant transformation of oral leukoplakia: a follow-up study

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Abstract

Objective

The main objective of the study was to identify the determinants that contribute to the malignant transformation of oral leukoplakia in a group of patients managed in secondary care. A secondary objective was to compare two dysplasia grading systems to determine their utility in assessing the prognosis.

Material and methods

The cohort consisted of 93 patients diagnosed during the period 2009–2013. The variables recorded and analysed included age and sex, clinical presentation (colour) and severity of oral epithelial dysplasia (OED) scored by the WHO (2005) and the binary grading systems. The planned management included excision of high-grade dysplasia and observation of low-grade dysplasia lesions based on the WHO grading system. Patient factors were transcribed from the pathology records and updated using a questionnaire sent out to the whole group of patients. Data were analysed using χ2 test and Kaplan-Meier analysis (P < 0.05).

Results

Complete follow-up data were available for 93 patients. Malignant transformation occurred in 7 patients (7.5%) during a mean follow-up period of 30 months. Among the surgically excised group (n = 51), a recurrence of oral leukoplakia was noted in 16 patients (31%). WHO OED grading (P = 0.02) and the presence of red areas (P = 0.012) were useful in predicting malignant transformation with severe epithelial dysplastic lesions and red and white mixed lesions showing higher rates.

Conclusion

Leukoplakias (7.5%) transformed over a mean follow-up period of 30 months. Dysplasia grading and the clinical appearance by colour (mixed white and red) were significant predictors of malignant transformation

Clinical significance

Patients with erythroleukoplakia and those diagnosed with moderate or severe epithelial dysplasia require more intensive interventions as such lesions have a higher risk of developing a malignancy.

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Funding

The work was supported by the Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya.

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Authors and Affiliations

  1. Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, 20400, Sri Lanka

    Primali Rukmal Jayasooriya, Kitmini Dayaratne & Upul Bandara Dissanayake

  2. Department of Medical Laboratory Sciences, Faculty of Allied Health Science, University of Peradeniya, Peradeniya, 20400, Sri Lanka

    Kitmini Dayaratne

  3. Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK

    Saman Warnakulasuriya

Authors
  1. Primali Rukmal Jayasooriya
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  2. Kitmini Dayaratne
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  3. Upul Bandara Dissanayake
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  4. Saman Warnakulasuriya
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Primali Jayasooriya, Kitmini Dayaratne and Upul Bandara Dissanayake. The first draft of the manuscript was written by Primali Jayasooriya, and it was critically reviewed with corrections by Prof Saman Warnakulasooriya. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Primali Rukmal Jayasooriya.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures (information gathered) in the study involving human participants were in accordance with the ethical standards of the institution (Faculty of Dental Sciences, University of Peradeniya) and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent was obtained from individuals included in the study at the time that questionnaires were posted to gather follow-up data.

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Jayasooriya, P.R., Dayaratne, K., Dissanayake, U.B. et al. Malignant transformation of oral leukoplakia: a follow-up study. Clin Oral Invest 24, 4563–4569 (2020). https://doi.org/10.1007/s00784-020-03322-4

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